Outcomes in patients with relapsed or refractory acute promyelocytic leukemia treated with or without autologous or allogeneic hematopoietic stem cell transplantation Journal Article
| Authors: | 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. |
| Article Title: | Outcomes in patients with relapsed or refractory acute promyelocytic leukemia treated with or without autologous or allogeneic hematopoietic stem cell transplantation |
| 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. © 2013 Elsevier Inc. All rights reserved. |
| Keywords: | adolescent; adult; cancer chemotherapy; cancer survival; clinical article; controlled study; event free survival; treatment outcome; treatment response; aged; overall survival; methotrexate; outcome assessment; follow up; liver toxicity; mucosa inflammation; kidney failure; stem cell transplantation; retrospective study; hematuria; cancer mortality; rash; arsenic trioxide; survival time; disease severity; feasibility study; promyelocytic leukemia; graft versus host reaction; long term care; allogeneic hematopoietic stem cell transplantation; seizure; infection prevention; cancer control; corticosteroid; tacrolimus; bone marrow transplantation; leukemia relapse; drug treatment failure; bacterial infection; retinoic acid; hemorrhagic cystitis; fluconazole; cytomegalovirus infection; mycosis; cyclosporin; voriconazole; autologous hematopoietic stem cell transplantation; infection complication; leukemia remission; recurrence free survival; valganciclovir; lung hemorrhage; acute promyelocytic leukemia; allogeneic transplantation; quinolone; autologous transplantation; sulfamethoxazole; trimethoprim; valaciclovir; acute myeloid leukemia; mycophenolic acid; gemtuzumab; arsenic derivative; hypervolemia |
| Journal Title: | Clinical Lymphoma, Myeloma and Leukemia |
| Volume: | 13 |
| Issue: | 4 |
| ISSN: | 2152-2650 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2013-08-01 |
| Start Page: | 485 |
| End Page: | 492 |
| Language: | English |
| DOI: | 10.1016/j.clml.2013.02.023 |
| PROVIDER: | scopus |
| PUBMED: | 23769669 |
| PMCID: | PMC4112369 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 4 September 2013" - "Source: Scopus" |
