A comparison of allogeneic bone marrow transplantation, autologous bone marrow transplantation, and aggressive chemotherapy in children with acute myeloid leukemia in remission: a report from the Children's Cancer Group

Intensive, myelosuppressive therapy is necessary to maximize outcomes for p atients with acute myeloid leukemia (AML), A comparison was made of 3 aggre ssive postremission approaches for children and adolescents with AML in a r andomized trial, CCG-2891,A total of 652 children and adolescents with AML who achieved remission on 2 induction regimens using identical drugs end do ses (standard and intensive timing) were eligible for allocation to allogen eic bone marrow transplantation (BMT) based on matched related donor status (n = 181) or randomization to autologous BMT (n = 177) or to aggressive hi gh-dose cytarabine-based chemotherapy (n = 179). Only 115 patients (18%) re fused to participate in the postremission phase of this study. Overall comp liance with the 3 allocated regimens was 90%, At 8 years actuarial, 54% +/- 4%(95% confidence interval) of all remission patients remain alive. Surviv al by assigned regimen ("intent to treat") is as follows: allogeneic BMT, 6 0% +/- 9%; autologous BMT, 48% +/- 8%; and chemotherapy, 53% +/- 8%, Surviv al in the allogeneic BMT group is significantly superior to autologous BMT (P = .002) and chemotherapy (P = .05); differences between chemotherapy and autologous BMT are not significant (P = .21). No potential confounding fac tors affected results. Patients receiving intensive-timing induction therap y had superior long-term survival irrespective of postremission regimen rec eived (allogeneic BMT, 70% +/- 9%; autologous BMT, 54% +/- 9%; chemotherapy , 57% +/- 10%), Allogeneic BMT remains the treatment of choice for children and adolescents with AML in remission, when a matched related donor is ava ilable. For all others, there is no advantage to autologous BMT; hence, agg ressive nonablative chemotherapy should be used. (C) 2001 by The American S ociety of Hematology.