Long-Term Results of Autologous Bone Marrow Transplantation as Late Intensification in AML

Most of the current strategies in the post-CR treatment of AML favour the use of intensive short-term consolidation followed by early intensification (Heil et al. 1995, Zittoun et al. 1995, Keating et al. 1998, Mitus et al. 1995). Allogeneic bone marrow transplantation (BMT) as early intensification has proved to be superior to autologous BMT or chemotherapy in many experiences, including some controlled trials (Mitus et al. 1995, Zittoun et al. 1997, Zittoun et al. 1995), although autologous BMT seems to offer a limited advantage over chemotherapy in terms of event free survival (EFS) (Zittoun et al. 1995). Furthermore, use of autografting as early intensification makes »ex-vivo« purging advisable in order to minimize the burden of residual leukemic cells in bone marrow harvesting (Gorin 1992), which implies a significant delay in engraftment and an increased risk of transplant-related mortality (Bishop et al. 1997, Damon et al. 1996, Lowenberg 1996). These negative considerations raise the question as to whether early intensification is really the best location for autologous BMT in the treatment of AML.