Allogeneic stem cell transplantation for advanced acute promyelocytic leukemia in the ATRA and ATO era

• Published in: Haematologica (Roma) Vol. 97; no. 11; pp. 1731 - 1735
• Main Authors: RAMADAN, Safaa M, DI VEROLI, Ambra, LO-COCO, Francesco, CAMBONI, Agnese, BRECCIA, Massimo, IORI, Anna Paola, AVERSA, Franco, CUPELLI, Luca, PAPAYANNIDIS, Cristina, BACIGALUPO, Andrea, ARCESE, William
• Format: Journal Article
• Language: English
• Published: Pavia Ferrata Storti Foundation 01.11.2012
• Subjects: Adolescent; Adult; Antineoplastic Agents - administration & dosage; Arsenicals - administration & dosage; Biological and medical sciences; Disease-Free Survival; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Humans; Leukemia, Promyelocytic, Acute - genetics; Leukemia, Promyelocytic, Acute - metabolism; Leukemia, Promyelocytic, Acute - mortality; Leukemia, Promyelocytic, Acute - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Oncogene Proteins, Fusion - genetics; Oncogene Proteins, Fusion - metabolism; Original and Brief Reports; Oxides - administration & dosage; Retrospective Studies; Stem Cell Transplantation; Survival Rate; Transplantation, Homologous; Tretinoin - administration & dosage; Antineoplastic agent; Promyelocytic leukemia; all-trans retinoic acid; Relapse; Hematology; Acute; Stem cell; Retinoid; Hematopoietic cell; Homograft; Arsenic trioxide; Malignant hemopathy; Allogeneic hematopoietic stem cell transplantation; acute promyelocytic leukemia; acute promyelocytic leukemia relapse; Graft; Advanced stage; allogeneic stem cell transplant; Cancer; M3 acute myelocytic leukemia; Tretinoin
• ISSN: 0390-6078; 1592-8721
• DOI: 10.3324/haematol.2012.065714

The role of allogeneic stem cell transplant in advanced acute promyelocytic leukemia patients who received standard first- and second-line therapy is still unknown. We report the outcome of 31 acute promyelocytic leukemia patients (median age 39 years) who underwent allogeneic transplant in second remission (n=15) or beyond (n=16). Sixteen patients were real-time polymerase chain reaction positive and 15 negative for PML/RARA pre-transplant. The 4-year overall survival was 62% and 31% for patients transplanted in second remission and beyond, respectively (P=0.05), and 64% and 27% for patients with pre-transplant negative and positive real-time polymerase chain reaction, respectively (P=0.03). The 4-year cumulative incidence of relapse was 32% and 44% for patients transplanted in second remission and beyond, respectively (P=0.37), and 30% and 47% for patients transplanted with negative and positive real-time polymerase chain reaction, respectively (P=0.30). Transplant-related mortality was 19.6%. In conclusion, allogeneic transplant is effective in advanced acute promyelocytic leukemia in the all-trans-retinoic acid and arsenic trioxide era, and should be considered once relapse is diagnosed.