***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE To compare intensive chemotherapy and HLA-identical allogeneic bone marrow transplantation ( BMT ) as postinduction therapy in young adults with acute myeloid leukemia ( AML ) . PATIENTS AND METHODS Seventy-eight consecutive AML patients younger than 40 years of age were treated according to a prospect i ve protocol in which every patient in complete remission ( CR ) with an HLA-identical sibling was scheduled to receive BMT rather than intensive chemotherapy consolidation . To minimize comparison biases , the availability or not of an HLA-identical sibling donor was considered to be the equivalent of genetic r and omization to the BMT or chemotherapy arm , respectively . RESULTS Fifty-eight patients ( 74 % ) achieved a CR . A donor was found for 27 patients ( BMT arm ) , and 20 of these patients were actually transplanted in first CR . The 31 patients without a donor were allocated to the chemotherapy arm . Patients in the two arms had similar disease characteristics at diagnosis and previous responses to induction therapy . The cumulative risk of relapse was 43 % + /- 24 % in the BMT arm and 67 % + /- 19 % in the chemotherapy arm ( P = .01 ) . The 7-year leukemia-free survival ( LFS ) rate was 41 % + /- 20 % in the BMT arm and 27 % + /- 16 % in the chemotherapy arm , a difference that is not statistically significant between the two arms . The overall survival rates were 41 % + /- 20 % and 46 % + /- 19 % , respectively . CONCLUSION In this study , the availability of an HLA-identical sibling donor was not associated with a better survival rate because of both the impossibility of some patients with a donor to receive BMT and the more efficient salvage treatment of patients who relapsed after intensive consolidation chemotherapy than of patients who relapsed after BMT Post-remission therapy in acute myeloid leukemia ( AML ) remains problematic . It has been demonstrated that younger patients can maintain longer complete remissions ( CR ) with aggressive post-remission therapies after induction treatment : allogeneic ( allo ) , autologous ( auto ) stem cell transplantation ( SCT ) , or intensive chemotherapy ( ICC ) . The purpose of our study was to identify the most important r and omized and controlled studies comparing these three therapeutic options , in order to draw conclusions and possible suggestions for post-remission therapy of AML , according to the evidence based medicine ( EBM ) rules . We performed an exhaustive analysis of the literature , search ing either in electronic data bases or among the references of the identified articles ( h and search ing ) . We search ed the MEDLINE computer data base for reports from 1985 through January 2005 and selected for analysis the clinical trials conducted over adults affected by newly diagnosed AML aged less than 65 years . The study design had to satisfy strict method ological criteria and must consider global mortality and /or disease free survival as primary outcomes . Overall we found 7750 papers ; by using the limits “ clinical trial ” as publication type , “ all adults 19 + years ” , we were able to select 344 papers . Among these , a further selection was made , based on two main clinical queries : 1 ) is auto-SCT superior to ICC/no other therapy in improving DFS and /or OS in adult AML patients in first CR ? 2 ) is allo-SCT superior to auto-SCT/other therapeutic options in improving DFS and /or OS in adult AML patients in first CR ? Concerning the first query , a possible advantage of auto-SCT over ICC was not clearly supported by data from clinical trials ; there is no evidence that auto-SCT is superior in terms of OS to chemotherapy . Nevertheless , the reported TRM has been significantly reduced within the past years . Thus , the percentage of patients suitable for auto-SCT in CR has increased . Moreover , the scarce data concerning the comparison between auto-SCT and chemotherapy in different subsets of patients are unable to suggest a differentiated approach in patients with high-risk , st and ard-risk or low-risk AML . Data from the literature show that patients with unfavorable risk disease are more often addressed to allo-SCT and patients with low-risk disease receive more often intensive consolidation chemotherapy . Concerning the second query , interpretation of data from the main prospect i ve studies about the role of allo-SCT in previously untreated AML is not easy . The first problem is the lack of real r and omized clinical trials ; in fact , according to the reported studies , AML patients generally receive allo-SCT on the basis of donor availability ( the so called “ genetic r and omization ” ) . The second problem is the frequent absence of intention to treat analysis . Despite method ological limitations , it was possible to compare allo-SCT with auto-SCT on a donor versus no-donor analysis and within risk groups . No overall benefit of allo-grafting on survival was demonstrated by any trial . In conclusion , the EBM approach highlighted the limitations observed in the published studies concerning consolidation therapy in AML ; some suggestions , emerging from non-r and omized , as well as r and omized studies , are adequate , but not conclusive . This point , coupled with the intrinsic complexity to study AML biological heterogeneity , is probably a major obstacle to draw conclusive evidence s for consolidation therapy in AML . These observations should plan to address new r and omized studies on AML therapy ; however , due to the emergence of genetic subgroups and new drugs targeting specific abnormalities , these trials should probably be design ed directly focusing on the single entities . In this way , the cure of AML could eventually become the cure of each specific AML subset with its peculiar biological , molecular and prognostic features Three intensive consolidation strategies are currently proposed to younger adults with acute myeloid leukemia ( AML ) in first complete remission ( CR ) : allogeneic or autologous bone marrow transplantation ( BMT ) and intensive consolidation chemotherapy ( ICC ) .  Patients aged 15 to 50 years with de novo AML received an induction treatment with 7 days of cytarabine and either idarubicin or rubidazone . After achievement of a CR , patients up to the age of 40 and having an HLA-identical sibling were assigned to undergo an allogeneic BMT . All the other patients received a first course of ICC with high-dose cytarabine and the same anthracycline as for induction . They were then r and omly assigned to either receive a second course of ICC with amsacrine and etoposide or a combination of busulfan and cyclosphosphamide followed by an unpurged autologous BMT .  Of 517 eligible patients , 367 had a CR , but only 219 ( 59.5 % ) actually received the planned intensive postremission treatment ( 73 allogeneic BMT , 75 autologous BMT , and 71 ICC ) . With a median follow-up of 62 months , the 4-year disease-free survival ( DFS ) of the 367 patients in CR was 39.5 % . The 4-year overall survival ( OS ) of the 517 eligible patients was 40.5 % . In multivariate analysis , DFS and OS were influenced only by the initial white blood cell count and by the French-American-British classification . The type of postremission therapy had no significant impact on the outcome . There was no difference in the 4-year DFS and OS between 88 patients for whom an allogeneic BMT was scheduled ( respectively , 44 % and 53 % ) and 134 patients of the same age category and without an HLA-identical sibling ( respectively , 38 % and 53 % ) . Similarly , there was no difference in the outcome between autologous BMT and ICC .  The 4-year DFS was 44 % for the 86 patients r and omly assigned to autologous BMT and 40 % for the 78 patients assigned to ICC ( P = .41 ) . The 4-year OS was similar in the two groups ( 50 % v 54.5 % , P = .72 ) . The median duration of hospitalization and thrombocytopenia were longer after autologous BMT ( 39 v 32 days , P = .006 , and 109.5 v 18.5 days , P = .0001 , respectively ) . After a first course of ICC , a second course of chemotherapy is less myelotoxic than an unpurged autologous BMT but yields comparable DFS and OS rates We previously reported that the Charlson Comorbidity Index ( CCI ) was useful for predicting outcomes in patients undergoing allogeneic hematopoietic cell transplantation ( HCT ) . However , the sample size of patients with scores of 1 or more , captured by the CCI , did not exceed 35 % . Further , some comorbidities were rarely found among patients who underwent HCT . Therefore , the current study was design ed to ( 1 ) better define previously identified comorbidities using pretransplant laboratory data , ( 2 ) investigate additional HCT-related comorbidities , and ( 3 ) establish comorbidity scores that were suited for HCT . Data were collected from 1055 patients , and then r and omly divided into training and validation sets . Weights were assigned to individual comorbidities according to their prognostic significance in Cox proportional hazard models . The new index was then vali date d. The new index proved to be more sensitive than the CCI since it captured 62 % of patients with scores more than 0 compared with 12 % , respectively . Further , the new index showed better survival prediction than the CCI ( likelihood ratio of 23.7 versus 7.1 and c statistics of 0.661 versus 0.561 , respectively , P < .001 ) . In conclusion , the new simple index provided valid and reliable scoring of pretransplant comorbidities that predicted nonrelapse mortality and survival . This index will be useful for clinical trials and patient counseling before HCT While the t(8;21 ) translocation is one of the most recurrent chromosomal abnormalities in acute myeloid leukemia , prognostic studies have been hampered by the relatively few number of patients reported . We thus performed a large retrospective study in 161 adults and children with t(8;21 ) acute myeloid leukemia , all prospect ively enrolled in 6 different trials conducted in France between 1987 and 1998 ( median follow-up 4.9 years ) . Prognostic studies were performed in the 154 patients who achieved a complete remission . Individual data were registered , including sex , age , blood and marrow counts , extramedullary disease , and cytogenetics . The value of allogeneic stem cell transplantation versus chemotherapy as postremission therapy was evaluated according to the intent-to-treat principle . Estimated 5-year disease-free survival ( DFS ) and overall survival were 52 % and 59 % , respectively . Outcome was not significantly better in patients from the stem cell transplantation group ( estimated 5-year DFS and survival , 56 % vs 52 % and 67 % vs 57 % ; P = .55 and .64 , respectively ) . White blood cell count ( WBC ) was the only identified prognostic factor . To further take into account the spontaneous differentiation potential of the leukemic clone , a WBC index was derived as the product of WBC by the ratio of marrow blast . This WBC index was a more powerful factor than the original WBC , allowing us to distinguish 3 subgroups of patients with different outcomes ( low index , < 2.5 ; intermediate index , 2.5 - 20 ; high index , 20 or more ) . In multivariate analysis , the WBC index was the only prognostic factor for DFS ( P = .003 ) , complete remission duration ( P = .002 ) , and overall survival ( P = .04 ) In the European Organization for Research and Treatment of Cancer Leukemia Group and Gruppo Italiano Malattie Ematologiche dell ' Adulto ( EORTC-LG/GIMEMA ) acute myeloid leukemia (AML)-10 trial , patients in first complete remission ( CR1 ) received a single intensive consolidation ( IC ) course . Subsequently , those patients younger than 46 years with an HLA-identical sibling donor were assigned to undergo allogeneic ( allo ) stem cell transplantation ( SCT ) , and patients without such a donor were planned for autologous ( auto ) SCT .  Between November 1993 and December 1999 , of 1198 patients aged younger than 46 years , 822 achieved CR . The study group constituted 734 patients who received IC : 293 had a sibling donor and 441 did not . Allo-SCT and auto-SCT were performed in 68.9 % and 55.8 % , respectively . Cytogenetic determination was successfully performed in 446 patients . Risk groups were good ( t(8;21 ) , inv16 ) , intermediate ( NN or -Y only ) , and bad/very bad ( all others ) . Median follow-up was 4 years ; 289 patients relapsed , 66 died in CR1 , and 293 died . Intention-to-treat analysis revealed that the 4-year disease-free survival ( DFS ) rate of patients with a donor versus those without a donor was 52.2 % versus 42.2 % , P = .044 ; hazard ratio = 0.80 , 95 % confidence interval ( 0.64 , 0.995 ) , the relapse incidence was 30.4 % versus 52.5 % , death in CR1 was 17.4 % versus 5.3 % , and the survival rate was 58.3 % versus 50.8 % ( P = .18 ) . The DFS rates in patients with and without a sibling don 
    Output:
    
Compared with nonallogeneic SCT therapies , allogeneic SCT has significant RFS and overall survival benefit for intermediate- and poor-risk AML but not for good-risk AML in first complete remission