High dose cytarabine or transplantation for consolidation of younger patients with acute myeloid leukemia

Collaborative study groups have invested considerable effort in the last de cade in defining the role of allogeneic and autologous bone marrow transpla ntation as consolidation treatment for first remission of acute myeloid leu kemia in younger patients. These efforts have been able, more precisely, to quantitate the degree to which patients who receive transplantation are a selected group. There has been a trend in recent years to increase the inte nsity of chemotherapy, which has improved treatment results, and the factor s which determine the risk of relapse have become more widely acknowledged. These developments have made the appropriate choice of consolidation treat ment less clear. Transplantation significantly reduces the risk of relapse and in some trials has improved the disease-free survival. However, a clear benefit in overall survival has been less clear and more difficult to demo nstrate, partly because some patients who fail first-line chemotherapy can be salvaged in second remission. The trials that included high-dose cytarab ine (ara-C) in the chemotherapy schedule were the ones in which no survival benefit was seen. (C) 2000 Lippincott Williams & Wilkins, Inc.