The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous versus allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20%. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n= 475 or peripheral blood, n= 428) versus autologous peripheral blood (n= 230). The 5-year cumulative incidence of treatment-related mortality was 19%(95% confidence interval, 16-23%), 20%(17-24%) and 8%(5-12%) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20%(17-24%), 26%(21-30%) and 45%(38-52%), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61%(56-65%) and 64%(59-68%); allogeneic peripheral blood 54%(49-59%) and 59%(54-64%); autologous peripheral blood 47%(40-54%) and 54%(47-60%); P= 0.13 and P= 0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); P= 0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); P= 0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n= 230)[relative risk 1.23 (0.98-1.55); P= 0.071] or allogeneic bone marrow/peripheral blood (n= 903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission.