[Bone marrow transplantation versus maintenance chemotherapy for adult acute leukemia in first remission]

We compared the outcome of bone marrow transplantation (BMT) with that of maintenance chemotherapy for adults with acute leukemia who achieved first remission in Japanese Red Cross Nagoya First Hospital. From 1976 to 1993, 17 patients with acute myelogenous leukemia (AML) and 10 patients with acute lymphoblastic leukemia (ALL) received allogeneic BMT from HLA genotypically identical siblings in first remission, 4 patients with ALL undertook purged autologous BMT using monoclonal antibody and complement, and 55 patients with AML and 27 patients with ALL were treated with maintenance chemotherapy. The estimated 6-year disease free survival (DFS) of AML patients was significantly higher in the BMT group than in the chemotherapy group (77.3% vs 42.6%; p < 0.01). For ALL patients, the estimated 6-year DFS was 72.5% in the allo-BMT group and 100% for the auto-BMT group, but no patient was disease free more than 2 years in the chemotherapy group (p < 0.0001). We conclude that BMT after several courses of consolidation chemotherapy is the optimal treatment of choice in patients with AML and ALL in first remission. A prospective study is needed to confirm the efficacy of BMT after intensive consolidation chemotherapy.