BONE-MARROW TRANSPLANTATION FOR ACUTE MYELOBLASTIC-LEUKEMIA - AN EBMT-LEUKEMIA-WORKING-PARTY PROSPECTIVE ANALYSIS FROM HLA-TYPING

The optimal post-remission therapy for patients with acute myeloblasti c leukaemia remains controversial. Allogeneic bone marrow transplantat ion, autologous bone marrow transplantation, and consolidation chemoth erapy are the major options. In order to evaluate their respective val ue the European Group for Bone Marrow Transplantation conducted a pros pective registration study. Patients with newly diagnosed acute myelob lastic leukaemia were registered at the time of HLA-typing and intenti on to treat in case of presence or absence of an HLA-identical donor w as recorded. 27/79 (34%) patients HLA-typed at diagnosis had an identi cal donor identified. The estimated survivals at 3 years from HLA-typi ng were 44% and 21% among patients with or without HLA-identical donor , respectively (P = 0.02). 22/26 (85%) patients for whom allogeneic bo ne marrow transplantation was intended were transplanted but only 15/4 7 (32%) patients for whom autologous bone marrow transplantation was i ntended were indeed transplanted (P<0.001). The survival was 50%, 29% and 17% (P=0.004) for patients treated with allogeneic bone marrow tra nsplantation, autologous bone marrow transplantation, or chemotherapy. respectively. 40/68 patients HLA-typed in first complete remission ha d an HLA-identical donor. The estimated 3-year survival among patients typed in first remission with and without HLA-identical donors was 42 % and 35% (n.s.), respectively. This technique of early patient regist ration illustrates the problems of patient selection during the course of the disease and might be used as a complement to randomized trials when comparing bone marrow transplantation and other treatment option s.