Outcomes in Patients With Relapsed or Refractory Acute Promyelocytic Leukemia Treated With or Without Autologous or Allogeneic Hematopoietic Stem Cell Transplantation |
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| Authors: | Naveen Pemmaraju Maria Florencia Tanaka Farhad Ravandi Heather Lin Veerabhadran Baladandayuthapani Gabriela Rondon Sergio A. Giralt Julianne Chen Sherry Pierce Jorge Cortes Hagop Kantarjian Richard E. Champlin Marcos De Lima Muzaffar H. Qazilbash |
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| Affiliation: | 1. Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX;2. Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX;3. Department of Stem Cell Transplantation, Memorial Sloan-Kettering Cancer Center, New York, NY;1. CHU Montpellier, Département d''Hématologie biologique, Hôpital Saint-Eloi, Montpellier, F-34000 France;2. CEA, iBEB, Service de Biochimie et Toxicologie Nucléaire, F-30207 Bagnols sur Cèze, France;1. Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil;2. Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP, Brazil;3. Universidade Federal de São Paulo (UNIFESP), Hospital São Paulo, São Paulo, SP, Brazil;1. Service de Rhumatologie, Hôpital Mongi Slim, La Marsa, Tunisia;2. Service de Hépato-Gastro-Entérologie, Hôpital Mongi Slim, La Marsa, Tunisia;3. Centre national de référence des maladies auto-immunes systémiques rares, CHU Hautepierre, Strasbourg, France;1. Section of Robotic & Laparoscopic Surgery, Catherine & Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA;2. Department of Urology, University of Verona, Azienda Universitaria Integrata, Verona, Italy;3. King Faisal Research & Specialist Hospital, Riyadh, Saudi Arabia |
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| Abstract: | BackgroundOutcomes in patients with acute promyelocytic leukemia (APL) have improved; however, a significant number of patients still relapse despite receiving all-trans-retinoic acid (ATRA) and arsenic-based therapies.Patients and MethodsOutcomes of patients with relapsed APL who were treated at our institution (1980-2010) and who received HCT were compared with those who received chemotherapy (CT) only.ResultsAmong 40 patients, 24 received HCT (autologous [auto] HCT, 7; allogeneic [allo] HCT, 14; both, 3); 16 received CT only. The median age at diagnosis was 36 years (range, 13-50 years), 31 years (range, 16-58 years), and 44 years (range, 24-79 years) for the auto-HCT, allo-HCT, and CT groups, respectively. Ten (100%) patients who received auto-HCT and 12 (71%) who received allo-HCT were in complete remission at the time of the HCT. The median follow-ups in the auto-HCT, allo-HCT, and CT groups were 74 months (range, 26-135 months), 118 months (range, 28-284 months), and 122 months (range, 32-216 months), respectively. Transplantation-related mortality (1 year) after auto-HCT and allo-HCT were 10% and 29%, respectively. The 7-year event-free survival after auto-HCT and allo-HCT was 68.6% and 40.6%, respectively (P = .45). The 7-year overall survival was 85.7%, 49.4%, and 40% in the auto-HCT, allo-HCT, and CT groups, respectively (P = .48).ConclusionBoth auto-HCT and allo-HCT are associated with durable remission and prolonged survival. All 3 strategies (auto-HCT, allo-HCT, CT) were found to be feasible in the relapsed APL setting and result in long-term disease control in selected patients. In this retrospective analysis, overall survival for patients who received HCT was not significantly better than patients who received CT only, but a trend toward better outcomes was seen in patients who underwent auto-HCT, although not statistically significant. |
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