Centre effect on treatment outcome for patients with untreated acute myelogenous leukaemia? An analysis of the AML 8A study of the Leukemia Cooperative Group of the EORTC and GIMEMA

In the AML 8A study patients were treated with remission-induction therapy followed by one consolidation course. Patients in complete remission (CR) w ere randomised between autologous bone marrow transplantation (ABMT) and a second intensive consolidation course, except for those with a histocompati ble sibling donor, who received allogeneic bone marrow transplantation (all oBMT). This analysis was performed to determine whether centres which only performed induction and consolidation therapy, achieved similar results as centres who also performed transplantation. 542/676 (80%) from transplantat ion centres and 150/194 (77%) from referring centres achieved CR, with an e arly death rate of 5% and 11%, respectively (P = 0.01). 66% of patients wit h a donor from transplantation centres received alloBMT in first CR compare d with 57% from referring centres (P = 0.2), Transplantation centres random ised 64% of patients without a donor, referring centres 47% (P = 0.04). The full protocol treatment was completed by 275/542 (51%) and 61/150 (41%) pa tients, respectively (P = 0.04). The overall survival rate at 6 years from diagnosis was 34% and 36%, respectively (P = 0.9). In conclusion, the type of centre did not appear to have an influence on overall survival. The feas ibility of the study was acceptable for both types of centres. The referrin g centres applied more selection for transplantation. Despite a more intens ive second-line treatment at transplantation centres, the overall outcome r emained similar to that of referring centres. (C) 1999 Elsevier Science Ltd . All rights reserved.