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Related Collections Neoplasia Clinical Trials and Observations Related Letters in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 1 January 2001, Vol. 97, No. 1, pp. 56-62 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS 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 William G. Woods, Steven Neudorf, Stuart Gold, Jean Sanders, Jonathan D. Buckley, Dorothy R. Barnard, Kathryn Dusenbery, Joetta DeSwarte, Diane C. Arthur, Beverly J. Lange, and Nathan L. Kobrinsky From the South Carolina Cancer Center, Columbia, SC; Children's Hospital of Pittsburgh, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Southern California School of Medicine, Los Angeles, CA; I.W.K. Grace Health Centre, Halifax, NS, Canada; University of Minnesota, Minneapolis, MN; Long Beach Memorial Medical Center, Long Beach, CA; National Cancer Institute, Bethesda, MD; Children's Hospital of Philadelphia, Philadelphia, PA; and the Roger Maris Cancer Center, Fargo, ND. Intensive, myelosuppressive therapy is necessary to maximize outcomes for patients with acute myeloid leukemia (AML). A comparison was made of 3 aggressive postremission approaches for children and adolescents with AML in a randomized trial, CCG-2891. A total of 652 children and adolescents with AML who achieved remission on 2 induction regimens using identical drugs and doses (standard and intensive timing) were eligible for allocation to allogeneic bone marrow transplantation (BMT) based on matched related donor status (n = 181) or randomization to autologous BMT (n = 177) or to aggressive high-dose cytarabine-based chemotherapy (n = 179). Only 115 patients (18%) refused to participate in the postremission phase of this study. Overall compliance with the 3 allocated regimens was 90%. At 8 years actuarial, 54% ± 4% (95% confidence interval) of all remission patients remain alive. Survival by assigned regimen ("intent to treat") is as follows: allogeneic BMT, 60% ± 9%; autologous BMT, 48% ± 8%; and chemotherapy, 53% ± 8%. Survival 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 factors affected results. Patients receiving intensive-timing induction therapy had superior long-term survival irrespective of postremission regimen received (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 available. For all others, there is no advantage to autologous BMT; hence, aggressive nonablative chemotherapy should be used. © 2001 by The American Society of Hematology.   CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Letters in Blood Online: Intensive chemotherapy versus bone marrow transplantation in pediatric acute myeloid leukemia: a matter of controversies Ursula Creutzig, Dirk Reinhardt, Martin Zimmermann, Thomas Klingebiel, and Helmut Gadner Blood 2001 97: 3671-3672. 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[Abstract] [Full Text] [PDF] U. Creutzig, D. Reinhardt, M. Zimmermann, T. Klingebiel, and H. Gadner Intensive chemotherapy versus bone marrow transplantation in pediatric acute myeloid leukemia: a matter of controversies Blood, June 1, 2001; 97(11): 3671 - 3672. [Full Text] [PDF] J. Horan and D. Korones Intensive chemotherapy and bone marrow transplantation for children with acute myeloid leukemia Blood, June 1, 2001; 97(11): 3672 - 3673. [Full Text] [PDF] D. Pinkel, W. G. Woods, B. J. Lange, F. O. Smith, and T. A. Alonzo Treatment of children with acute myeloid leukemia Blood, June 1, 2001; 97(11): 3673 - 3675. [Full Text] [PDF]

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