Outcomes in Patients With Relapsed or Refractory Acute Promyelocytic Leukemia Treated With or Without Autologous or Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

Outcomes in patients with acute promyelocytic leukemia have improved; however, a subset of patients relapse despite receiving all-trans-retinoic acid and/or arsenic-based therapies. Among 40 patients with acute promyelocytic leukemia who were treated at our institution (1980–2010), 24 received hematopoietic stem cell transplantation (HCT) (autologous HCT, 7; allogeneic HCT, 14; both, 3); 16 received chemotherapy only. All 3 strategies (autologous HCT, allogeneic HCT, chemotherapy) were feasible in patients with relapsed acute promyelocytic leukemia and result in long-term disease control in selected patients. 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.

New frontiers of target therapy in oncology: acute promyelocytic leukemia

“…In a retrospective analysis, overall survival for patients who underwent transplant was not significantly better than those who received only chemotherapy, but the trend of slightly better outcome was noted in the group with autologous HSCT, although not statistically significant (88).…”

Molecular and hematologic relapses in adult patients with acute promyelocytic leukemia: a cohort study

“…Patients treated with salvage chemotherapy alone have lower survival compared to those submitted to SCT 17 . Auto-SCT should be performed when the patient achieves MR, but may increase the risk of a new relapse.…”

“…Auto-SCT should be performed when the patient achieves MR, but may increase the risk of a new relapse. Patients submitted to auto-SCT have higher rates of overall and disease-free survival than those who undergo allogeneic SCT 17 . Allogeneic SCT is indicated when the patient does not achieve molecular response after consolidation.…”

Contemporary Treatment of APL

“…Investigators from MD Anderson retrospectively reviewed outcomes in 40 relapsed APL patients undergoing autologous SCT, allogeneic SCT or chemotherapy alone. They found no difference in EFS or OS between groups but the numbers were small and there was a trend toward improved outcomes in the autologous SCT group [66]. Therefore, autologous SCT in second CMR is recommended in patients able to receive the high dose chemotherapy required for conditioning.…”