Transplants in AML

Three therapies are widely-used to treat acute myelogenous leukemia (AML): allogenic bone marrow transplants, autotransplants and chemotherapy. Which of these therapies is best is controversial. Analyzing and comparing results of these therapies is complex and controversial. Comparisons of published data are flawed by biased reporting and subject selection. Randomized trials are also reported but are limited by small numbers of subjects and the question of whether their conclusions apply to most persons with AML. Hypotheses being tested in randomized trials are often misunderstood or relevant to only a subset of persons with AML. Furthermore, in many trials a substantial proportion of subjects do not receive the intended treatment. Observational data bases are also used to compare results of different AML therapies. Although this is probably the most effective analytic approach, substantial differences in outcome-related variable between treatment groups make complex statistical adjustment necessary. Validity of these adjustments is controversial. Limitations of these diverse approaches to comparing results of different therapies of AML suggests that a precise answer to the question of how best to treat AML is unlikely to be forthcoming. This uncertainty is further confounded by the considerable subjectivity that influences how physicians choose between alternative therapies. The net result of these considerations is a consensus approach to treating AML is unlikely to develop, probably because results of diverse treatments are not very different.