Author(s): Pemmaraju N, Tanaka MF, Ravandi F, Lin H, Baladandayuthapani V, , Pemmaraju N, Tanaka MF, Ravandi F, Lin H, Baladandayuthapani V,
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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. Published by Elsevier Inc.
This article was published in Clin Lymphoma Myeloma Leuk
and referenced in Journal of Blood Disorders & Transfusion