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Between 1996 and 2004, a total of 708 patients were enrolled in the acute myeloid leukaemia (AML) ‘96 and ‘02 studies of the East German Study Group (OSHO). Of these, 138 patients (19.5%) had unfavourable cytogenetics defined as complex karyotype, del (5q)/-5, del (7q)/-7, abn (3q26) and abn (11q23). In all, 77 (56%) achieved complete remission 1 (CR1) after induction chemotherapy and were eligible for haematopoietic cell transplantation (HCT). HCT was performed after a median of two cycles of consolidation chemotherapy (CT) in the AML ‘96 and one cycle in the AML ‘02 study (P=0.03). After a median follow-up of 19 months, overall survival (OS) at two years was significantly better in the donor group (52±9%) versus the no-donor group (24±8%; P=0.005). Differences in outcomes were mainly because of a lower relapse incidence in patients after HCT (39±11%) compared with a higher relapse incidence in patients undergoing CT (77±10%; P=0.0005). Treatment-related mortality was low and not statistically significantly different between the two treatment groups (15±7 and 5±5% for HCT and chemotherapy, respectively; P=0.49).We conclude that early HCT from related or unrelated donors led to significantly better OS and leukaemia-free survival compared with chemotherapy in patients with unfavourable karyotype.Leukemia (2009) 23, 635–640; doi:10.1038/leu.2008.352; published online 8 January 2009 [ABSTRACT FROM AUTHOR]