TY - JOUR
T1 - Outcomes in patients with relapsed or refractory acute promyelocytic leukemia treated with or without autologous or allogeneic hematopoietic stem cell transplantation
AU - Pemmaraju, Naveen
AU - Tanaka, Maria Florencia
AU - Ravandi, Farhad
AU - Lin, Heather
AU - Baladandayuthapani, Veerabhadran
AU - Rondon, Gabriela
AU - Giralt, Sergio A.
AU - Chen, Julianne
AU - Pierce, Sherry
AU - Cortes, Jorge
AU - Kantarjian, Hagop
AU - Champlin, Richard E.
AU - De Lima, Marcos
AU - Qazilbash, Muzaffar H.
PY - 2013/8
Y1 - 2013/8
N2 - Background: Outcomes 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 Methods: Outcomes 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. Results: Among 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). Conclusion: Both 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.
AB - Background: Outcomes 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 Methods: Outcomes 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. Results: Among 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). Conclusion: Both 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.
KW - Acute myeloid leukemia
KW - Acute promyelocytic leukemia
KW - Allogeneic transplantation
KW - Autologous transplantation
KW - Bone marrow transplantation
KW - Stem cell transplantation
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U2 - 10.1016/j.clml.2013.02.023
DO - 10.1016/j.clml.2013.02.023
M3 - Article
C2 - 23769669
AN - SCOPUS:84880759655
SN - 2152-2650
VL - 13
SP - 485
EP - 492
JO - Clinical Lymphoma, Myeloma and Leukemia
JF - Clinical Lymphoma, Myeloma and Leukemia
IS - 4
ER -
