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KMID : 1142020220570030197
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Blood Research
2022 Volume.57 No. 3 p.197 ~ p.206
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Treatment for relapsed acute promyelocytic leukemia: what is the best post-remission treatment?
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Min Gi-June
Cho Byung-Sik
Park Sung-Soo
Park Silvia
Jeon Young-Woo
Yahng Seung-Ah
Shin Seung-Hawn
Yoon Jae-Ho
Lee Sung-Eun
Eom Ki-Seong
Kim Yoo-Jin
Lee Seok
Min Chang-Ki
Cho Seok-Goo
Lee Jong-Wook
Kim Hee-Je
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Abstract
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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.
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KEYWORD
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Acute promyelocytic leukemia, Relapse, Arsenic trioxide, Stem cell transplantation, Post-remission therapy
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