Autologous and allogeneic stem-cell transplantation as salvage treatment of acute promyelocytic leukemia initially treated with all-trans-retinoic acid:: A retrospective analysis of the European acute promyelocytic leukemia group

被引:91
作者
de Botton, S [1 ]
Fawaz, A [1 ]
Chevret, S [1 ]
Dombret, H [1 ]
Thomas, X [1 ]
Sanz, M [1 ]
Guerci, A [1 ]
San Miguel, J [1 ]
de la Serna, J [1 ]
Stoppa, AM [1 ]
Reman, O [1 ]
Stamatoulas, A [1 ]
Fey, M [1 ]
Cahn, JY [1 ]
Sotto, JJ [1 ]
Bourhis, JH [1 ]
Parry, A [1 ]
Chomienne, C [1 ]
Degos, L [1 ]
Fenaux, P [1 ]
机构
[1] Univ Paris 13, Hop Avicenne, Serv Hematol Clin, F-93009 Bobigny, France
关键词
D O I
10.1200/JCO.2005.03.127
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose To retrospectively determine the outcome of acute promyelocytic leukemia (APL) patients who underwent autologous or allogeneic stem-cell transplantation (SCT) during second complete remission. Patients and Methods Of 122 relapsing patients included in two successive multicenter APL trials who achieved hematological second complete remission (generally after a salvage regimen of all-transretinoic acid [ATRA] combined with chemotherapy), 73 (60%) received allogeneic (n = 23) or autologous (n = 50) SCT. Results Seven-year relapse-free survival (RFS), event-free survival (EFS), and overall survival (OS) in the autologous SCT group were 79.4%, 60.6%, and 59.8%, respectively, with a transplant-related mortality (TRM) of 6%. Of the 28 and two patients autografted with negative and positive, respectively, reverse transcriptase-polymerase chain reaction before auto SCT, three (11%) and one relapsed, respectively. In the allogeneic SCT group, 7-year RFS, EFS, and OS were 92.3%, 52.2%, and 51.8%, respectively, with 39% TRM. OS was significantly better in the autologous SCT group than in the allogeneic SCT group (P = .04), whereas RFS and EFS did not differ significantly (P = .19 and P = .11, respectively). In patients not receiving transplantation, 7-year RFS, EFS, and OS were 38%, 30.4%, and 39.5%, respectively. Conclusion These retrospective data suggest that autologous SCT is very effective in APL relapsing after treatment with ATRA if performed in molecular remission. Allogeneic SCT yields few relapses, but it is associated with high TRM when performed after salvage with very intensive chemotherapy. Salvage with arsenic trioxyde, which has lower toxicity, should further improve the outcome of relapsing APL, especially before allogeneic SCT.
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页码:120 / 126
页数:7
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