In a nutshell
This study aimed to compare the outcomes of allogeneic (allo) and autologous (auto) hematopoietic stem cell transplant (HSCT) for patients with acute promyelocytic leukemia (APL) in second complete remission (CR2).
This study concluded that autoHSCT resulted in better outcomes for these patients.
APL is a subtype of acute myeloid leukemia (AML). Primary treatments involve all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) chemotherapy combinations. However, a few patients relapse after these treatments. Current guidelines recommend HSCT after salvage treatment for these patients. Salvage treatments are given after first-line treatments have failed. When salvage treatments succeed, patients are said to be in CR2.
HSCT involves transplanting healthy stem cells from the patient (auto) or from a donor (all) to replace cancer cells damaged by therapy. It is not clear which type of HSCT (auto or allo) is more effective for patients with APL in CR2.
Methods & findings
This study involved 569 patients with APL in CR2. 228 patients received alloHSCT. 341 received autoHSCT. The average follow-up was 60 months in the allo- group and 38.7 months in the auto- group.
The percentage of patients that had the transplanted cells make new healthy white blood cells after 60 days was similar between the allo- (98.5%) and auto- (98.7%) groups. Slightly more patients in the allo- group relapsed after 2 years (28%) compared to the auto- group (22.9%).
Patients in the allo- group had a higher mortality risk not related to relapse (17.3%) after 2 years compared to those in the auto- group (2.7%). The leukemia-free survival rate after 2 years was significantly higher in the auto- group (74.5%) for the autoHSCT group compared to 54.7% for the alloHSCT group. The overall survival rate was also significantly higher with autoHSCT (82.4%) compared to the alloHSCT group (64.3%).
The bottom line
This study concluded that autoHSCT resulted in better survival outcomes for patients with APL in CR2.
The fine print
This study was based on medical records. Some information might have been missing. This might affect the results.
Published By :
Bone Marrow Transplantation
Dec 15, 2020