Autologous is superior to allogeneic hematopoietic cell transplantation for acute promyelocytic leukemia in second complete remission Journal Article

Authors: Holter Chakrabarty, J. L.; Rubinger, M.; Le-Rademacher, J.; Wang, H. L.; Grigg, A.; Selby, G. B.; Szer, J.; Rowe, J. M.; Weisdorf, D. J.; Tallman, M. S.
Article Title: Autologous is superior to allogeneic hematopoietic cell transplantation for acute promyelocytic leukemia in second complete remission
Abstract: To identify favored choice of transplantation in patients with acute promyelocytic leukemia (APL) in second complete remission, we studied 294 patients with APL in second complete remission (CR2) receiving allogeneic (n = 232) or autologous (n = 62) hematopoietic cell transplantation (HCT) reported to the Center for International Blood and Marrow Transplantation Research (CIBMTR) from 1995 to 2006, including 155 with pre-HCT PML/RAR status (49% of allogeneic and 66% of autologous). Patient characteristics and transplantation characteristics, including treatment-related mortality, overall survival (OS), and disease-free survival, were collected and analyzed for both univariate and multivariate outcomes. With median follow-up of 115 (allogeneic) and 72 months (autologous), 5-year disease-free survival (DFS) favored autologous with 63% (49% to 75%), compared with allogeneic at 50% (44% to 57%) (P = .10). OS was 75% (63% to 85%) versus 54% (48% to 61%) (P = .002), for autologous and allogeneic transplantation, respectively. Multivariate analysis showed significantly worse DFS after allogeneic HCT (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.16 to 3.06; P = .011) and age>40 years (HR, 2.30; 95% CI, 1.44 to 3.67; P = .0005). OS was significantly worse after allogeneic HCT (HR, 2.66; 95% CI, 1.52 to 4.65; P = .0006); age>40 (HR, 3.29; 95% CI, 1.95 to 5.54; P < .001), and first complete remission < 12 months (HR, 1.56; 95% CI, 1.07 to 2.26; P = .021). Positive pre-HCT PML-RAR status in 17 of 114 allogeneic and 6 of 41 receiving autologous transplantation did not influence relapse, treatment failure, or survival in either group. The survival advantage for autografting was attributable to increased treatment-related mortality (TRM) in the allogeneic group of 30% compared to 2% in the autologous group, in addition to the added mortality associated with GVHD. We conclude that autologous HCT yields superior OS for APL in CR2. Long-term DFS in autologous recipients, even with minimal residual disease-positive grafts, remains an important subject for further study. © 2014 American Society for Blood and Marrow Transplantation.
Keywords: adult; treatment failure; major clinical study; overall survival; cancer patient; disease free survival; outcome assessment; follow up; retrospective study; minimal residual disease; promyelocytic leukemia; allogeneic hematopoietic stem cell transplantation; leukemia relapse; autologous hematopoietic stem cell transplantation; leukemia remission; allogeneic transplantation; autologous transplantation; apl; human; male; female; article
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 20
Issue: 7
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2014-07-01
Start Page: 1021
End Page: 1025
Language: English
DOI: 10.1016/j.bbmt.2014.03.025
PROVIDER: scopus
PUBMED: 24691221
PMCID: PMC4097890
Notes: Biol. Blood Marrow Transplant. -- Export Date: 8 July 2014 -- CODEN: BBMTF -- Source: Scopus
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MSK Authors
  1. Martin Stuart Tallman
    501 Tallman