Is allogeneic bone marrow transplantation the first choice for acute leukemia in first remission? From chemotherapeutical point of view

Since 1984 several prospective randomized clinical trials have been reported that the disease-free survival for BMT in first remission was superior to chemotherapy for AML. However, there raise two main controversies about these conclusions. First, in last several years intensive consolidation therapy was applied and nearly 50% of patients are reported to be alive 5 years. Second 10% to 50% BMT scheduled patients were excepted mainly because of their condition. On the contrary, about ALL, even these several years, age is the still main risk factor independently of therapy. Reports with good 5 year disease free survival all due to their patients' youth. The prognosis of ALL patients age 30 or more are poor and BMT seems to be a first choice in first-remission in patients under age 40. Only large-scale prospective randomized study among patients with or without HLA-identical donors will give the answer to this important issue.