Treatment for relapsed acute promyelocytic leukemia: what is the best post-remission treatment?
- Author:
Gi-June MIN
1
;
Byung-Sik CHO
;
Sung-Soo PARK
;
Silvia PARK
;
Young-Woo JEON
;
Seung-Ah YAHNG
;
Seung-Hawn SHIN
;
Jae-Ho YOON
;
Sung-Eun LEE
;
Ki-Seong EOM
;
Yoo-Jin KIM
;
Seok LEE
;
Chang-Ki MIN
;
Seok-Goo CHO
;
Jong Wook LEE
;
Hee-Je KIM
Author Information
- Publication Type:ORIGINAL ARTICLE
- From:Blood Research 2022;57(3):197-206
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:Arsenic trioxide (ATO) is the standard treatment for relapsed acute promyelocytic leukemia (APL). However, consensus on post-remission therapies is still lacking.
Methods:We evaluated 52 patients who experienced relapse following initial treatment of APL between 2000 and 2019 at Catholic Hematology Hospital. Among them, 41 patients received reinduction treatment, 30 with ATO-based regimen, whereas 11 with conventional intensive chemotherapy (IC).
Results:The ATO reinduction group showed a significantly higher second molecular complete remission (mCR2) rate, superior neutrophil and platelet recovery, and a lower infection rate than the IC reinduction group. No significant differences were observed in survival outcomes after post-remission treatment among the ATO-based (N=19), autologous (N=12), and allogeneic (N=6) hematopoietic stem cell transplantation (HSCT) groups. In the ATO-based and autologous HSCT groups, among patients with mCR2 after ATO reinduction, nine and five patients experienced a second relapse, respectively (50.7% vs. 41.7%, P =0.878). Among these patients, seven received salvage allogeneic HSCT; six remained alive. The other seven patients received ATO without HSCT. Five died from disease progression, and two survived and have been in mCR2 since.
Conclusion:Post-remission treatment outcomes of patients with relapsed APL were not significantly different, regardless of the treatment option, suggesting the feasibility of ATO-based treatment without HSCT in mCR2. Allogeneic HSCT may be an effective salvage treatment modality for patients with a second relapse. Owing to a few cases of relapsed APL, multicenter prospective studies may help elucidate the efficacy of each post-remission treatment.
