Summary:We have analyzed the long-term outcome and toxicities in 98 patients with high-risk acute myelogenous leukemia (AML) who were treated with autologous bone marrow transplantation (ABMT) and monitored for a median observation period of 11.67 years. Between 1983 and 1994, 98 patients in our institution in first or second and higher complete remission (CR) underwent total body irradiation and high-dose cyclophosphamide prior to ABMT purged with mafosfamide. Twenty-seven out of the 90 evaluable patients (30%) were alive and in continuous CR for a median of 11.67 years (range, 6.39-15.53) after ABMT and could be considered as 'cured'. Among the 90 patients, 39 were transplanted at first CR and had a significantly higher survival rate than those transplanted at у2 CR. Younger patients (Ͻ40 years) had a better prognosis and patients with FAB M1-4 had a more favorable outcome than those with M5. Longterm complications included four patients with cardiac complications, two with renal insufficiency. Five developed HCV infections, four myelodysplastic syndrome. The incidence of cataract among the long-term survivors was 44.4%. Therefore, a significant number of adult patients with AML in first CR derived longterm benefit from ABMT, despite the risks of a few long-term complications and of MDS (4.4%). Bone Marrow Transplantation (2002) 30, 15-22. doi: 10.1038/sj.bmt.1703586 Keywords: autologous bone marrow transplantation (ABMT); purging; long-term outcome; long-term toxicity; secondary myelodysplasia Although the rate of complete remission (CR) for adult patients with acute myelogenous leukemia (AML) treated with conventional chemotherapy ranges between 65 and 80%, the disease-free survival at 5 years remains disap- pointingly low, and ranges between 10 and 15% in patients Ͼ55 years and 20-40% in younger patients.