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Hematopoietic stem cell transplantation for adults with relapsed acute promyelocytic leukemia in second complete remission

Bone Marrow Transplantation volume 56, pages 1272–1280 (2021)Cite this article

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Abstract

We retrospectively compared outcomes of a large series of adult patients with APL in CR2 receiving alloHSCT (n = 228) or autoHSCT (n = 341) reported to the European Society for Blood and Marrow Transplantation from January 2004 to December 2018. The 2-year cumulative incidence of non-relapse mortality was significantly higher for alloHSCT 17.3% (95% CI 12.5–22.8) compared with autoHSCT 2.7% (95% CI 1.2–5) (p = 0.001), while differences in relapse rate were not significant (28% versus 22.9%; p = 0.28). Leukemia-free survival (LFS) and overall survival (OS) favored autoHSCT with 74.5% (95% CI 69–79.2) and 82.4% (95% CI 77.3–86.5) compared with alloHSCT with 54.7% (95% CI 47.5–61.3) (p = 0.001) and 64.3% (95% CI 57.2–70.6), respectively (p = 0.001 and p = 0.001). Multivariable analysis showed significantly worse LFS after alloHSCT (HR 0.49; 95% CI 0.37–0.67; p < 0.0001), older age (p = 0.001), and shorter time from diagnosis to transplant (p = 0.00015). Similar results were obtained for OS. The study shows that autoHSCT resulted in better survival outcomes (LFS and OS) for APL in CR2. These results were mainly due to reduced NRM in the autoHSCT as compared to alloHSCT.

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Fig. 1
Fig. 2: Transplantation outcomes according to donor source in APL patients in second complete remission.
Fig. 3: Transplantation outcomes according to donor source in MRD-negative APL patients in second complete remission.

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Author notes

  1. These authors contributed equally: Jaime Sanz, Miguel A. Sanz

Authors and Affiliations

  1. Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain

    Jaime Sanz & Miguel A. Sanz

  2. CIBERONC, Instituto Carlos III, Madrid, Spain

    Jaime Sanz & Miguel A. Sanz

  3. EBMT Paris Office, Hospital Saint Antoine, Paris, France

    Myriam Labopin & Norbert-Claude Gorin

  4. Hôpital Saint Antoine, Sorbonne University, Department of Hematology, Paris, France

    Myriam Labopin, Norbert-Claude Gorin & Mohamad Mohty

  5. Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

    Mahmoud Aljurf

  6. Hospital dos Capuchos, Servico de Hematologia, Lisbon, Portugal

    Aida Botelho Sousa

  7. University Hospital Birmingham NHSTrust, Queen Elizabeth Medical Centre, Edgbaston, Department of Haematology, Birmingham, UK

    Charles Craddock

  8. Rambam Health Care Campus, Department of Hematology & BMT and Faculty of Medicine, Technion, Haifa, Israel

    Tsila Zuckerman

  9. Hôpital Lyon Sud, Hospices Civils de Lyon Pierre Benite, Pierre-Bénite, France

    Hélène Labussière-Wallet

  10. Inst. Português de Oncologia do Porto, BMT Unit, Porto, Portugal

    Antonio Campos

  11. ASST Grande Ospedale Metropolitano Niguarda, Hematology Department, Milano, Italy

    Giovanni Grillo

  12. Gazi University Faculty of Medicine, Hematology, Turkey

    Zubeyde Nur Ozkurt

  13. Erasmus MC Cancer Institute,University Medical Center Rotterdam, Department of Hematology, Rotterdam, The Netherlands

    J. J. Cornelissen

  14. Dél-pesti Centrumkórház, Department of Haematology and Stem Cell Transplant, Albert, Hungary

    Péter Reményi

  15. Stem Cell Transplantation Unit (CTMO), Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, Reggio Calabria, Italy

    Massimo Martino

  16. ICO–Hospital Duran i Reynals, L’Hospitalet de Llobregat, Barcelona, Spain

    Rocio Parody Porras

  17. Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel

    Arnon Nagler

  18. ALWP of the EBMT Office, Saint Antoine Hospital, Paris, France

    Arnon Nagler

Authors
  1. Jaime Sanz
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  2. Myriam Labopin
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  3. Miguel A. Sanz
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  12. J. J. Cornelissen
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  17. Norbert-Claude Gorin
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  18. Mohamad Mohty
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Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

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Correspondence to Jaime Sanz.

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Sanz, J., Labopin, M., Sanz, M.A. et al. Hematopoietic stem cell transplantation for adults with relapsed acute promyelocytic leukemia in second complete remission. Bone Marrow Transplant 56, 1272–1280 (2021). https://doi.org/10.1038/s41409-020-01162-0

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