High dose cytarabine or transplantation for consolidation of younger patients with acute myeloid leukemia [review]

Collaborative study groups have invested considerable effort in the last decade in defining the role of allogeneic and autologous bone marrow transplantation as consolidation treatment for first remission of acute myeloid leukemia in younger patients. These efforts have been able, more precisely, to quantitate the degree to which patients who receive transplantation are a selected group. There has been a trend in recent years to increase the intensity of chemotherapy, which has improved treatment results, and the factors which determine the risk of relapse have become more widely acknowledged. These developments have made the appropriate choice of consolidation treatment less clear. Transplantation significantly reduces the risk of relapse and in some trials has improved the disease-free survival. However, a clear benefit in overall survival has been less clear and more difficult to demonstrate, partly because some patients who fail first-line chemotherapy can be salvaged in second remission. The trials that included high-dose cytarabine (ara-C) in the chemotherapy schedule were the ones in which no survival benefit was seen