title: Autologous transplant remains the preferred therapy for relapsed APL in CR2.
abstract: Despite their favorable prognosis, 10-20% of acute promyelocytic leukemia (APL) patients relapse. Reinduction therapy is often followed by autologous hematopoietic cell transplantation (auto-HCT). Arsenic trioxide (ATO) has become part of standard reinduction and is often followed by auto-HCT. Data on patients in CR2 were collected from two large transplant registries (Center for International Blood and Marrow Transplant Research (CIBMTR) and European Group for Blood and Marrow Transplant (EBMT)) and two specialty referral centers. The outcome of patients in CR2 who received only ATO-based therapy as reinduction was retrospectively compared with those who got an auto-HCT, with or without ATO. Prognostic factors included age, disease risk, extramedullary disease and duration of CR1. Of 207 evaluable patients, the median age was 31.5 years, 15.3% had extramedullary disease and median WBC at diagnosis was 4.8 × 10(9)/L. Sixty-seven patients received ATO alone and 140 underwent auto-HCT. The groups were comparable for age, gender, extramedullary disease, risk group and duration of CR1. At 5 years, overall survival (OS) was 42% and 78% for the ATO-only and auto-HCT groups, respectively (P<0.001). In addition, OS was associated with longer duration of CR1 (P=0.002), but not with disease risk at diagnosis. These data suggest that auto-HCT for APL patients in CR2 results in better OS than ATO-based therapy alone.
authors.affiliation: Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: C
authors.initials: C
authors.lastname: Ganzel
authors.affiliation: Department of Hematology, Christian Medical College & Hospital, Vellore, India.
authors.forename: V
authors.initials: V
authors.lastname: Mathews
authors.affiliation: Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: K
authors.initials: K
authors.lastname: Alimoghaddam
authors.affiliation: Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Ghavamzadeh
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: D
authors.initials: D
authors.lastname: Kuk
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Devlin
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: Bone Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN, USA.
authors.forename: D
authors.initials: D
authors.lastname: Weisdorf
authors.affiliation: Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA.
authors.forename: D
authors.initials: D
authors.lastname: Douer
authors.affiliation: Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.|Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: J M
authors.initials: JM
authors.lastname: Rowe
authors.affiliation: Saint-Antoine Hospital and University Pierre & Marie Curie, Paris, France.|Acute Leukemia Working Party, EBMT Paris Study Office/CEREST-TC, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Polge
authors.affiliation: Hematology Department, Hospital Clinic, Institut d'investigacions Biomediques August Pi i Sunyer, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Esteve
authors.affiliation: Acute Leukemia Working Party, EBMT Paris Study Office/CEREST-TC, Paris, France.|Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Saint-Antoine Hospital and University Pierre & Marie Curie, Paris, France.|Acute Leukemia Working Party, EBMT Paris Study Office/CEREST-TC, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Mohty
authors.affiliation: Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Tallman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D060828:Induction Chemotherapy; D007223:Infant; D015473:Leukemia, Promyelocytic, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001152:Arsenicals; D010087:Oxides; D000077237:Arsenic Trioxide