title: Role of hematopoietic stem cell transplantation for relapsed acute promyelocytic leukemia: a retrospective analysis of JALSG-APL97.
abstract: For patients with relapsed acute promyelocytic leukemia (APL), all-trans retinoic acid-based salvage regimens can achieve second complete remission (CR2), but the optimal post-remission strategy for APL patients after CR2 remains unclear. Hematopoietic stem cell transplantation (HSCT) during CR2 might be effective, but data on the role of HSCT for APL patients after CR2 are limited in Japan. We retrospectively analyzed outcomes for 57 relapsed APL patients who achieved CR2 in the JALSG APL97 study. Of those, six received autologous (auto)-HSCT, 21 received allogeneic (allo)-HSCT, and 30 received various regimens other than HSCT. The 5-year event-free survival (EFS) rate, overall survival (OS) rate and cumulative incidence of relapse (CIR) were 50.7%, 77.4% and 51.0% in the non-HSCT group, 41.7%, 83.3% and 58.3% in the auto-HSCT group and 71.1%, 76.2% and 9.8% in the allo-HSCT group, respectively. Both the EFS rate and CIR were significantly better in the allo-HSCT group than in other groups. Allo-HSCT appears effective in APL patients in CR2, with a low relapse rate beyond a relatively early transplantation-related mortality (19%). Among older patients (age ≥40 years), the 5-year OS was significantly better in the non-HSCT group than in the HSCT group (78.0% vs 40.5%; P = 0.04). Further prospective studies with larger patient numbers are required to confirm the impact of HSCT alone and in combination with arsenic trioxide on outcomes for patients with APL in CR2.
authors.affiliation: Department of Hematology, Yokohama Saiseikai Nanbu Hospital, Yokohama, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujita
authors.forename: Norio
authors.initials: N
authors.lastname: Asou
authors.forename: Masako
authors.initials: M
authors.lastname: Iwanaga
authors.forename: Rie
authors.initials: R
authors.lastname: Hyo
authors.forename: Shosaku
authors.initials: S
authors.lastname: Nomura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kiyoi
authors.forename: Masaya
authors.initials: M
authors.lastname: Okada
authors.forename: Youko
authors.initials: Y
authors.lastname: Inaguma
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Matsuda
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamauchi
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ohtake
authors.forename: Tohru
authors.initials: T
authors.lastname: Izumi
authors.forename: Chiaki
authors.initials: C
authors.lastname: Nakaseko
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shinagawa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Takeshita
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Kazunori
authors.initials: K
authors.lastname: Ohnishi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Miyawaki
authors.forename: Tomoki
authors.initials: T
authors.lastname: Naoe
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use; D001565:Benzoates / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D013764:Tetrahydronaphthalenes / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014212:Tretinoin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D001565:Benzoates; D010087:Oxides; D013764:Tetrahydronaphthalenes; C061133:tamibarotene; D014212:Tretinoin; D000077237:Arsenic Trioxide