Acute myeloid leukemia in first remission: to choose transplantation or not?

A 42-year-old woman presented with bruising and fatigue. Her WBC count was 10,370/μL, with a differential showing 5% polys, 5% monos, 10% lymphocytes, and 80% myeloid-appearing blasts, some of which contained Auer rods (Fig 1). Bone marrow examination revealed 90% infiltration with myeloid-appearing blasts, and flow cytometry analysis confirmed the diagnosis of acute myeloid leukemia (AML) with expression of CD33, CD13, and CD117. Cytogenetics revealed a normal female karyotype; molecular testing for NPM1, FLT3-ITD, and CEBPαmutations revealed wild-type status for each gene. The patient received induction therapy with daunorubicin 90 mg/m(2) per day for 3 days and continuous-infusion cytarabine 100 mg/m(2) per day for 7 days. After an induction course complicated by Gram-negative bacterial sepsis, her counts recovered by day 32, and bone marrow examination 6 weeks after diagnosis showed a complete remission. One week later she feels well and has normal physical and laboratory examinations. She is an only child (but has a common HLA type) and presents for discussion of postremission therapy options.