Blood Res.  2022 Sep;57(3):197-206. 10.5045/br.2022.2022060.

Treatment for relapsed acute promyelocytic leukemia: what is the best post-remission treatment?

Affiliations
  • 1Department of Hematology, 1Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 2Yeouido St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 3Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
  • 4Eunpyeong St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

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.

Keyword

Acute promyelocytic leukemia; Relapse; Arsenic trioxide; Stem cell transplantation; Post-remission therapy

Figure

  • Fig. 1 Flow chart of acute promyelocytic leukemia patients who relapsed after administration of first-line treatment.

  • Fig. 2 Comparison of clinical outcomes of patients with relapsed acute promyelocytic leukemia based on consolidation regimen.


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