***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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    ***EXAMPLES*** 
    Input: PURPOSE This study was conducted to assess the comparative values of allogeneic bone marrow transplantation ( BMT ) and autologous bone marrow transplantation ( ABMT ) with sequential postremission chemotherapy ( SPC ) in children with acute myelogenous leukemia ( AML ) in first remission . PATIENTS AND METHODS From March 1987 to March 1990 , 161 assessable patients younger than 15 years of age with newly diagnosed AML were treated uniformly with two courses of daunorubicin and st and ard-dose cytarabine . After initial consolidation with a course of daunorubicin , cytarabine , and thioguanine ( DAT ) , patients in complete remission ( CR ) were r and omized to receive either ABMT or SPC , except for those with an HLA-matched sibling who were assigned to undergo BMT . SPC consisted of three additional courses of DAT , followed by three pairs of drugs administered sequentially for a total of six cycles . RESULTS Overall , 127 of 161 patients attained CR ( 79 % ) . The estimated probabilities of survival and event-free survival ( EFS ) at 5 years for all patients were 42 % and 25 % , respectively ( median follow-up , 28 months ) . For the 127 complete responders , the 5-year probability of disease-free survival ( DFS ) was 31 % , with a cumulative risk of relapse of 64 % . For the purpose of this study , all complete responders were evaluated for analysis of disease outcome according to the intent-to-treat principle , regardless of whether they actually received the intended therapy . The 5-year DFS was 51 % for the BMT group ( n = 24 ) , significantly higher ( P = .03 ) than that observed for the other cohorts : 21 % for ABMT ( n = 35 ) , 27 % for SPC ( n = 37 ) , and 34 % for a group of 31 nonr and omized ( NR ) patients . Bone marrow relapse was the most frequent cause of postremission failure in all therapeutic subgroups , including the BMT cohort , in which no deaths attributable to the toxicity of the procedure were recorded . CONCLUSION The results of this study show that BMT is more effective than ABMT or SPC in preventing leukemia relapse and extending DFS duration in children with AML in first remission The main difference between the two cooperative studies on therapy of childhood acute myelogenous leukemia AML-BFM-78 and AML-BFM-83 was the addition of an 8-day ADE ( cytosine arabinoside , daunorubicin , etoposide ) induction treatment in the second study . Due to this intensification , the relapse rate , but not the rate of induction failures , was reduced . The probability of a 6-year event-free survival increased from 38 % , SD 4 % , in study AML-BFM-78 to 49 % , SD 4 % , in study AML-BFM-83 , P = .08 . The improvement of the 6-year event-free interval ( EFI ) was significant in the second study ( 61 % , SD 4 % , versus 47 % , SD 5 % , P less than .05 ) ; it was restricted to the FAB types M1 through M4 ( EFI : 67 % , SD 5 % , versus 45 % , SD 5 % , P less than .01 ) . The difference in EFI seen in FAB M5 was not statistically significant ( EFI : 40 % , SD 10 % , versus 63 % , SD 11 % , NS ) . According to the results of the second study , two different risk groups ( low and high ) could be identified by combinations of predominantly pretherapeutic parameters . The low risk group , comprising 37 % of the patients who achieved complete remission , included the FAB types with granulocytic differentiation and specific additional features : FAB M1 with Auer rods , FAB M2 with white blood cell count of less than 20,000/microL , FAB M3 all patients , and FAB M4 with eosinophilia . The 6-year Kaplan-Meier estimation of EFI is 91 % , SD 4 % , compared with 42 % , SD 6 % in the high risk group . In future studies based on the AML-BFM-83 treatment , bone marrow transplantation in first remission should be m and atory only for children of the high risk group BACKGROUND Three strategies are used to prevent relapse in patients with acute myeloid leukaemia in first remission . Most of those with suitable donors are offered allogeneic haemopoietic-stem-cell transplant . Other patients may receive intensive chemotherapy or autologous transplantation ; we undertook this r and omised prospect i ve trial to assess which is the better option . METHODS After three courses of intensive chemotherapy , bone marrow was harvested from patients ( < 56 years of age ) in remission who lacked an HLA-matched sibling donor . These patients were then r and omised to receive , after one more course of chemotherapy , no further treatment ( n=191 ) or an autologous bone-marrow transplant ( BMT ) after preparation with cyclophosphamide and total-body irradiation ( n=190 ) . Outcome comparisons were by intention to treat with adjustment for the most important risk factors for relapse . FINDINGS 381 patients were r and omised ( 38 % of those eligible ) . Of the 190 patients allocated autologous BMT , 126 received it . On intention-to-treat analysis the number of relapses was substantially lower in the autologous BMT group than in the group assigned no further treatment ( 64/190 [ 37 % ] vs 101/191 [ 58 % ] , p=0.0007 ) , result ing in superior disease-free survival at 7 years ( 53 vs 40 % ; p=0.04 ) . These benefits were observed in all risk groups and age-groups . There were more deaths in remission in the autologous BMT group than in the no further treatment group ( 22 [ 12 % ] vs 7 [ 4 % ] , p=0008 ) . In children ( < 15 years ) and patients with good-risk disease , survival from relapse in the no further treatment group was 35 % and 38 % at 2 years . There was an overall survival advantage in the autologous BMT group at 7 years ( 57 vs 45 % , p=0.2 ) . INTERPRETATION The addition of autologous BMT to four courses of intensive chemotherapy substantially reduces the risk of relapse in all risk groups , leading to improvement in long-term survival . The good chance of salvage for children or patients with good-risk disease who relapse from chemotherapy , and the mortality , morbidity , late effects , and expense of autologous BMT , suggest that delay of autograft until second remission in these two groups may be appropriate 359 eligible children with acute myeloid leukaemia ( AML ) entered the MRC AML 10 trial between May 1988 and March 1995 . Patients received four courses of intensive induction and consolidation chemotherapy , with or without subsequent autologous ( A-BMT ) or allogeneic ( allo-BMT ) bone marrow transplant . There were r and omized comparisons of thioguanine versus etoposide in induction and of A-BMT versus not . Allo-BMT was recommended for patients with a HLA-matched sibling and was evaluated by donor versus no donor comparison . The complete remission rate was 92 % . In first remission there were 20 deaths during consolidation chemotherapy and 11 after BMT ( 8/61 allo-BMTs . 1/60 A-BMTs and 2/4 matched unrelated donor transplants ) . The relapse rate was low , decreasing from 26 % in the first year to 2 % in the fourth . Long-term outcome was excellent with survival at 7 years from entry of 56 % and event-free survival of 48 % . There were no significant differences between thioguanine and etoposide , whereas both A-BMT and allo-BMT reduced relapse risk but did not produce a significant survival benefit . It appears that over half the children entered into AML 10 are cured , a result which compares favourably with other reported series . We conclude that four courses of intensive chemotherapy are an effective approach to the treatment of paediatric AML , which avoids the acute toxicity and long-term side-effects of BMT and also avoids the need for prolonged maintenance therapy or cranial irradiation PURPOSE The objectives of this study were to determine if the addition of etoposide , thioguanine , and dexamethasone to daunorubicin and cytarabine ( five-drug regimen ) during induction would improve remission induction rates and survival of children with acute myeloid leukemia ( AML ) when compared with the st and ard regimen of cytarabine and daunorubicin ( 7 + 3 ) and whether allogeneic bone marrow transplantation ( BMT ) or intensive chemotherapy consolidation with or without maintenance would give a superior outcome . PATIENTS AND METHODS A total of 591 assessable children with AML entered Childrens Cancer Group ( CCG ) trial 213 between January 1986 and February 1989 . The status of patients as of September 1 , 1992 forms the basis of this report . The results were compared with previous AML studies . RESULTS The projected survival rate of all patients at 5 years is 39 % ( event-free survival [ EFS ] rate , 31 % ) , which is superior to that of the prior CCG study ( P = .01 ) . The induction rate was 79 % for 7 + 3 and 76 % for the five-drug regimen ( not significant ) . Comparisons of BMT to chemotherapy favored BMT , but these differences do not always reach statistical significance ( eg , 5-year disease-free survival [ DFS ] rate , 46 % v 38 % [ P = .06 ] with donor available and 54 % v 37 % [ P = .002 ] if treated according to protocol intent ) . No benefit for maintenance therapy was found and , in some comparisons , it was inferior to discontinuation of therapy ( 5-year survival rate , 46 % v 68 % , P < .01 ) . CONCLUSION The 5-year EFS rate of patients with AML is 31 % and has improved . The five-drug induction regimen is no better than st and ard induction , BMT appears superior to chemotherapy , and maintenance therapy was not beneficial Timed sequencing of cycles of induction chemotherapy in acute myeloid leukemia ( AML ) has been proposed as a way to achieve maximal leukemic cell kill through recruitment and synchronization of residual neoplastic cells . Furthermore , whether intensive induction therapy should be continued in the presence of profound myelosuppression is an important question . The Children 's Cancer Group ( CCG ) conducted a prospect i ve r and omized trial in which 589 patients with AML were r and omized at diagnosis to one of two induction approaches involving a 4-day cycle of five active chemotherapeutic agents , with the second cycle administered either 10 days after the first cycle , despite low or dropping blood counts ( intensive timing ) , or 14 days or later from the beginning of the first cycle , depending on bone marrow status ( st and ard timing ) . All patients achieving remission received a total of four cycles of induction therapy . They were then allocated to allogeneic bone marrow transplantation ( BMT ) if a compatible family donor was present or r and omized to aggressive nonmyeloablative therapy or to myeloablative therapy with purged autologous BMT rescue . The three postremission arms remain coded . Induction success and median days to complete induction were similar for the 295 patients r and omized to the intensive timing arm ( 75 % , 99 days ) compared with the 294 patients r and omized to the st and ard timing arm ( 70 % , 105 days ; P = .18 for remission ) . However , a marked improvement in outcome was demonstrated in patients r and omized to the intensive timing arm , with an actuarial event-free survival at 3 years of 42 % + /- 7 % ( 95 % confidence interval [ CI ] ) versus 27 % + /- 6 % for patients on the st and ard timing arm ( P = .0005 ) . Disease-free survival results at 3 years from the end of induction were superior for patients receiving intensively timed induction therapy ( N = 211 ) , 55 % + /- 9 % versus 37 % + /- 9 % for st and ard timing patients ( N = 195 , P = .0002 ) , with a median follow-up from achieving remission of 28 months . Superior results were documented for patients receiving intensive timing irrespective of the postremission therapy to which they were allocated . Intensively timed induction therapy for patients with AML markedly improves event-free survival , even for patients undergoing myeloablative therapy with BMT rescue . Without controlling for the type of induction therapy received , results of various BMT studies in AML comparing different preparative regimens will be difficult to interpret The objective of this study was to compare allogeneic bone marrow transplantation ( BMT ) with high-dose cytarabine containing chemotherapy in children with acute myeloid leukemia ( AML ) in first complete remission ( CR ) . One hundred and seventy-one children were enrolled on the LAME89/91 protocol .  Induction chemotherapy was a combination of cytarabine and mitoxantrone . After achieving CR , patients who had an HLA-identical sibling donor 
    Output:
    
Results of the analysis showed that allocation to BMT reduced risk of relapse and improved disease-free and overall survival .
In conclusion , BMT from a histocompatible family donor improves patient outcome .
Data are insufficient to determine whether this is true for all subgroups of AML , and whether ABMT is superior to non-myeloablative chemotherapy .