Value of allogeneic stem cell transplantation versus autologous stem cell transplantation and chemotherapy in patients with myelodysplastic syndromes and secondary acute myeloid leukemia: a prospective randomized European intergroup trial

Background: Allogeneic stem cell transplantation (alloSCT) is usually considered the only curative treatment option for patients with advanced or transformed myelodysplasia (MDS) in complete remission (CR), but postremission chemotherapy and autologous stem cell transplantation are potential alternatives, especially in patients older 45 years. Design and Methods: We evaluated after intensive antileukemic remission-induction chemotherapy the impact of the presence of a HLA-identical sibling donor on an intention-to treat basis. Additionally, all patients without a sibling donor in complete remission after the first consolidation course were randomized between autologous peripheral blood SCT (APSCT) versus a second consolidation course consisting of high dose cytarabine (HDAC). Results: The 4-year survival of the 341 evaluable patients was 28%. Four-year survival after achieving CR of patients