Autologous bone marrow transplantation for children with AML in first remission
In Children's cancer group (CCG) 2891, newly diagnosed patients with AML were randomized between standard and intensive timing induction therapies. Patients in first remission who lacked an HLA matched family donor were randomized between an autologous bone marrow transplantation (ABMT) where marrow was purged with 4 hydroperoxycyclophosphamide and consolidation chemotherapy. One hundred and thirty seven patients received an ABMT. Myeloid and platelet engraftment occurred at a median of 44 and 42 days, respectively. Disease-free survival (DFS), relapse-free survival and overall survival at 8 years post induction were 47% (95% confidence interval (CI): 38–55), 50% (CI: 42–59) and 55% (CI: 46–63), respectively. Multivariate analysis of DFS showed WBC <50 000/μl and having received intensively timed induction therapy were associated with improved DFS. Recipients who received intensive timed induction therapy and whose WBC was less than 50 000/μl had a DFS at 8 years of 62% (CI: 49–73). Conversely, recipients who received intensive timed induction therapy patients whose WBC was ⩾50 000/μl had a DFS of 33% (CI: 17–50), P=0.003. The results confirm previous studies that ABMT is effective post remission therapy for pediatric patients with AML in first remission.