Intensive chemotherapy versus allogeneic bone marrow transplantation in first-remission acute myeloid leukemia.

At present, using the most contemporary management techniques, it would appear that allogeneic bone marrow transplantation and intensive chemotherapy offer a roughly equivalent potential for curing adult patients with AML in first remission. Each form of treatment has drawbacks--the limited eligibility and continued high rate of early death associated with the allogeneic transplant procedure and the significantly greater likelihood of relapse, as well as the risk for drug-induced, life-threatening toxicities observed following the administration of chemotherapy. Future efforts should be directed at improving each of these treatment techniques, perhaps through kinetic synchronization of leukemic cells by hematopoietic growth factors to make chemotherapy more potent and by better understanding and then harnessing the "graft-versus-leukemia" effect which appears so instrumental in reducing the relapse rate following allografting.