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Bone Marrow Transplantation or Chemotherapy After Remission Induction for Adults with Acute Nonlymphoblastic Leukemia: A Prospective Comparison

FREDERICK R. APPELBAUM, M.D.; STEVE DAHLBERG, M.S.; E. DONNALL THOMAS, M.D.; C. DEAN BUCKNER, M.D.; MARTIN A. CHEEVER, M.D.; REGINALD A. CLIFT, F.I.M.L.S.; JOHN CROWLEY, Ph.D.; H. JOACHIM DEEG, M.D.; ALEXANDER FEFER, M.D.; PHILIP D. GREENBERG, M.D.; MARSHALL KADIN, M.D.; WALTER SMITH, M.D.; PATRICIA STEWART, M.D.; KEITH SULLIVAN, M.D.; RAINER STORB, M.D.; and PAUL WEIDEN, M.D.
[+] Article and Author Information

Grant support: in part by grants CA 18029, CA 15704, CA 18221, and CA 37402 from the National Cancer Institute, Department of Health and Human Services. Dr. Thomas is the recipient of Research Career Award AI 02425 from the Institute of Allergy and Infectious Diseases.

▸Requests for reprints should be addressed to Frederick R. Appelbaum, M.D.; Fred Hutchinson Cancer Research Center, 1124 Columbia Street; Seattle, WA 98104.


Seattle, Washington


©1984 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1984;101(5):581-588. doi:10.7326/0003-4819-101-5-581
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We compared the outcome of marrow transplantation with that of continued chemotherapy for adults with acute nonlymphoblastic leukemia who achieve a first remission. From May 1977 to July 1982, 111 consecutive adults (ages 17 to 50) with newly diagnosed acute nonlymphoblastic leukemia were treated with induction chemotherapy. Ninety patients (81%) had a complete remission. Forty-four remission patients had available donors: 33 received a transplant and 11 did not. Forty-six patients in remission without matched donors were treated with continued chemotherapy. Kaplan-Meier estimates of 5-year, disease-free survival from complete remission are 49% ± 18% for the transplant group and 20% ± 13% for the chemotherapy group. When compared to the chemotherapy group, patients undergoing transplantation had a higher risk of dying during the first 6 months after remission induction but a lower risk of dying thereafter. Within the transplant group, only age influenced survival. Within the chemotherapy group, a leukocyte count of greater than 10 000 mm3 at diagnosis, a French-American-British (FAB) Cooperative Group morphologic status of M-4, M-5, or M-6, and the presence of infection at diagnosis were all associated with shorter survival.

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