Autologous or Allogeneic Bone Marrow Transplantation Compared with Intensive Chemotherapy in Acute Myelogenous Leukemia
Year: 1995
Type: article
Study design: Clinical Trial
Abstract: BACKGROUND: Allogeneic or autologous bone marrow transplantation and intensive consolidation chemotherapy are used to treat acute myelogenous leukemia in a first complete remission. METHODS: After induction treatment with daunorubicin and cytarabine, patients who had a complete remission received a first course of intensive consolidation chemotherapy, combining intermediate-dose cytarabine and amsacrine. Patients with an HLA-identical sibling were assigned to undergo allogeneic bone marrow transplantation; the others were randomly assigned to undergo autologous bone marrow transplantation (with unpurged bone marrow) or a second course of intensive chemotherapy, combining high-dose cytarabine and daunorubicin. Comparisons were made on the basis of the intention to treat. RESULTS: A total of 623 patients had a complete remission; 168 were assigned to undergo allogeneic bone marrow transplantation, and 254 were randomly assigned to one of the other two groups. Of these patients, 343 completed the treatment assignment: 144 in the allogeneic-transplantation group, 95 in the autologous-transplantation group, and 104 in the intensive-chemotherapy group. The relapse rate was highest in the intensive-chemotherapy group and lowest in the allogeneic-transplantation group, whereas the mortality rate was highest after allogeneic transplantation and lowest after intensive chemotherapy. The projected rate of disease-free survival at four years was 55 percent for allogeneic transplantation, 48 percent for autologous transplantation, and 30 percent for intensive chemotherapy. However, the overall survival after complete remission was similar in the three groups, since more patients who relapsed after a second course of intensive chemotherapy had a response to subsequent autologous bone marrow transplantation. Other differences were also observed, especially with regard to hematopoietic recovery (it occurred later after autologous transplantation) and the duration of hospitalization (it was longer with bone marrow transplantation). CONCLUSIONS: Autologous as well as allogeneic bone marrow transplantation results in better disease-free survival than intensive consolidation chemotherapy with high-dose cytarabine and daunorubicin. Transplantation soon after a relapse or during a second complete remission might also be appropriate.
Source: New England Journal of Medicine
Authors: Robert A. Zittoun, Franco Mandelli, Roel Willemze, Theo de Witte, Boris Labar, Luigi Resegotti, Franco Leoni, Eugenio Damasio, Giuseppe Visani, Giuseppe Papa, Francesco Caronia, Marcel Hayat, Pierre Stryckmans, Bruno Rotoli, Pietro Leoni, Marc E. Peetermans, Murielle Dardenne, Maria Luce Vegna, Maria Concetta Petti, Gabriel Solbu, Stefan Suciu
Institutions: Hôtel-Dieu de Paris, Sapienza University of Rome, Leiden University, Azienda Ospedaliero Universitaria San Giovanni Battista, University of Florence, Ospedale Policlinico San Martino, University of Bologna, University of Rome Tor Vergata, Ospedale Vincenzo Cervello, Institut Gustave Roussy, Institut Jules Bordet, University of Naples Federico II, Marche Polytechnic University, University of Antwerp, European Organisation for Research and Treatment of Cancer, European Organisation for Research and Treatment of Cancer
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2013051826