Clinical decision-making: acute myelogenous leukemia in first complete remission

Most patients with acute myelogenous leukemia achieve complete remission but are not cured with chemotherapy alone. Bone marrow transplantation is an alternative to chemotherapy, but there is controversy as to which patients benefit from transplantation.

Outcome can be predicted by, and therapy tailored to, specific prognostic factors such as age and karyotype. Younger patients with good-risk karyotypes such as t(8;21) and inv16 have a long-term disease-free survival rate of 75% or more with chemotherapy alone. Patients with poor-risk karyotypes have a survival rate less than 10% with chemotherapy alone and may benefit from bone marrow transplantation, which is associated with cures in up to 50% of patients. Most patients do not have a compatible donor for allogeneic transplantation. High-dose chemotherapy and autologous bone marrow transplantation is an option for patients with no marrow donor, and has cure rates of as high as 50%. Patients with intermediate-risk karyotypes generally have a survival rate between 20% and 50% with chemotherapy alone. It is uncertain if allogeneic or autologous bone marrow transplantation offers any additional advantage in this group.