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4, 6- 8 We previously reported a single center study on the outcome of allogeneic transplant in 17 relapsed APL patients for whom pre-transplant minimal residual disease (MRD) assessment was available. To date, four major studies have explored the role of allogeneic transplants in adult APL patients in the ATRA era. 4, 5 Therefore, allogeneic transplant in APL is generally recommended for patients failing to achieve first or second molecular remission, or in those experiencing short duration of first remission. While the graft- versus-leukemia effect of allogeneic transplant offers the best anti-leukemia activity in patients with advanced disease, its success is notoriously hampered by transplant-related mortality which increases considerably in the matched unrelated and haploidentical settings. 1, 3 Due to the very low number of relapses and the above variables, appropriately designed randomized studies to compare the different consolidation approaches in CR2 are deemed not feasible. Selection of the appropriate consolidation depends on variables which include patient age and performance status, duration of first remission, donor availability, and minimal residual disease status after salvage therapy, as determined by nested real-time polymerase chain reaction (RT-PCR) or quantitative PCR of the PML/RARA fusion gene. 1 However, the best option for consolidation therapy for APL in second complete remission (CR2) is still unknown.
ALLOGENEIC STEM CELL TRANSPLANT PLUS
2, 3 Available options for consolidation after remission re-induction include continued ATO and/or chemotherapy plus ATRA, with or without autologous or allogeneic transplants. 1 As for patients who relapse after this regimen, arsenic trioxide (ATO) with or without other agents is considered the treatment of choice as it produces second molecular remission rates of up to 80%. 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.Īpproximately 80% of patients with acute promyelocytic leukemia (APL) are cured with modern all-trans-retinoic acid (ATRA) and chemotherapy. 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). 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). Sixteen patients were real-time polymerase chain reaction positive and 15 negative for PML/RARA pre-transplant. 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). The role of allogeneic stem cell transplant in advanced acute promyelocytic leukemia patients who received standard first- and second-line therapy is still unknown.