Outcomes in patients with relapsed or refractory acute promyelocytic leukemia treated with or without autologous or allogeneic hematopoietic stem cell transplantation

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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)485-492
Number of pages8
JournalClinical Lymphoma, Myeloma and Leukemia
Volume13
Issue number4
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

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Acute Promyelocytic Leukemia
Hematopoietic Stem Cell Transplantation
Drug Therapy
Survival
Arsenic
Tretinoin
Disease-Free Survival
Transplantation
Recurrence

Keywords

  • Acute myeloid leukemia
  • Acute promyelocytic leukemia
  • Allogeneic transplantation
  • Autologous transplantation
  • Bone marrow transplantation
  • Stem cell transplantation

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Outcomes in patients with relapsed or refractory acute promyelocytic leukemia treated with or without autologous or allogeneic hematopoietic stem cell transplantation. / Pemmaraju, Naveen; Tanaka, Maria Florencia; Ravandi, Farhad; Lin, Heather; Baladandayuthapani, Veerabhadran; Rondon, Gabriela; Giralt, Sergio A.; Chen, Julianne; Pierce, Sherry; Cortes, Jorge; Kantarjian, Hagop; Champlin, Richard E.; De Lima, Marcos; Qazilbash, Muzaffar H.

In: Clinical Lymphoma, Myeloma and Leukemia, Vol. 13, No. 4, 01.08.2013, p. 485-492.

Research output: Contribution to journalArticle

Pemmaraju, N, Tanaka, MF, Ravandi, F, Lin, H, Baladandayuthapani, V, Rondon, G, Giralt, SA, Chen, J, Pierce, S, Cortes, J, Kantarjian, H, Champlin, RE, De Lima, M & Qazilbash, MH 2013, 'Outcomes in patients with relapsed or refractory acute promyelocytic leukemia treated with or without autologous or allogeneic hematopoietic stem cell transplantation', Clinical Lymphoma, Myeloma and Leukemia, vol. 13, no. 4, pp. 485-492. https://doi.org/10.1016/j.clml.2013.02.023
Pemmaraju, Naveen ; Tanaka, Maria Florencia ; Ravandi, Farhad ; Lin, Heather ; Baladandayuthapani, Veerabhadran ; Rondon, Gabriela ; Giralt, Sergio A. ; Chen, Julianne ; Pierce, Sherry ; Cortes, Jorge ; Kantarjian, Hagop ; Champlin, Richard E. ; De Lima, Marcos ; Qazilbash, Muzaffar H. / Outcomes in patients with relapsed or refractory acute promyelocytic leukemia treated with or without autologous or allogeneic hematopoietic stem cell transplantation. In: Clinical Lymphoma, Myeloma and Leukemia. 2013 ; Vol. 13, No. 4. pp. 485-492.
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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 - 2013/8/1

Y1 - 2013/8/1

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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