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

15 Scopus citations

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 2013

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

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    Pemmaraju, N., Tanaka, M. F., Ravandi, F., Lin, H., Baladandayuthapani, V., Rondon, G., Giralt, S. A., Chen, J., Pierce, S., Cortes, J., Kantarjian, H., Champlin, R. E., De Lima, M., & Qazilbash, M. H. (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, 13(4), 485-492. https://doi.org/10.1016/j.clml.2013.02.023