de Botton S, Fawaz A, Chevret S, Dombret H, Thomas X, Sanz M, Guerci A, San Miguel J, de la Serna J, Stoppa A M, Reman O, Stamatoulas A, Fey M, Cahn J Y, Sotto J J, Bourhis J H, Parry A, Chomienne C, Degos L, Fenaux P
Service d'Hématologie Clinique, Hôpital Avicenne, Université Paris XIII, 125 rue de Stalingrad, 93009 Bobigny, France.
J Clin Oncol. 2005 Jan 1;23(1):120-6. doi: 10.1200/JCO.2005.03.127. Epub 2004 Nov 8.
To retrospectively determine the outcome of acute promyelocytic leukemia (APL) patients who underwent autologous or allogeneic stem-cell transplantation (SCT) during second complete remission.
Of 122 relapsing patients included in two successive multicenter APL trials who achieved hematological second complete remission (generally after a salvage regimen of all-trans-retinoic acid [ATRA] combined with chemotherapy), 73 (60%) received allogeneic (n = 23) or autologous (n = 50) SCT.
Seven-year relapse-free survival (RFS), event-free survival (EFS), and overall survival (OS) in the autologous SCT group were 79.4%, 60.6%, and 59.8%, respectively, with a transplant-related mortality (TRM) of 6%. Of the 28 and two patients autografted with negative and positive, respectively, reverse transcriptase-polymerase chain reaction before auto SCT, three (11%) and one relapsed, respectively. In the allogeneic SCT group, 7-year RFS, EFS, and OS were 92.3%, 52.2%, and 51.8%, respectively, with 39% TRM. OS was significantly better in the autologous SCT group than in the allogeneic SCT group (P = .04), whereas RFS and EFS did not differ significantly (P = .19 and P = .11, respectively). In patients not receiving transplantation, 7-year RFS, EFS, and OS were 38%, 30.4%, and 39.5%, respectively.
These retrospective data suggest that autologous SCT is very effective in APL relapsing after treatment with ATRA if performed in molecular remission. Allogeneic SCT yields few relapses, but it is associated with high TRM when performed after salvage with very intensive chemotherapy. Salvage with arsenic trioxyde, which has lower toxicity, should further improve the outcome of relapsing APL, especially before allogeneic SCT.
回顾性确定在第二次完全缓解期接受自体或异基因干细胞移植（SCT）的急性早幼粒细胞白血病（APL）患者的预后。
在两项连续的多中心APL试验中纳入的122例复发患者中，有73例（60%）在达到血液学第二次完全缓解（通常在全反式维甲酸[ATRA]联合化疗的挽救方案后）接受了异基因（n = 23）或自体（n = 50）SCT。
自体SCT组的7年无复发生存率（RFS）、无事件生存率（EFS）和总生存率（OS）分别为79.4%、60.6%和59.8%，移植相关死亡率（TRM）为6%。在自体SCT前分别进行逆转录酶-聚合酶链反应检测为阴性和阳性的28例和2例自体移植患者中，分别有3例（11%）和1例复发。在异基因SCT组中，7年RFS、EFS和OS分别为92.3%、52.2%和51.8%，TRM为39%。自体SCT组的OS显著优于异基因SCT组（P = .04），而RFS和EFS无显著差异（分别为P = .19和P = .11）。未接受移植的患者，7年RFS、EFS和OS分别为38%、30.4%和39.5%。
这些回顾性数据表明，如果在分子缓解期进行，自体SCT对经ATRA治疗后复发的APL非常有效。异基因SCT复发率低，但在经过非常强烈的化疗挽救后进行时，与高TRM相关。使用毒性较低的三氧化二砷进行挽救治疗，应能进一步改善复发APL的预后，尤其是在异基因SCT之前。
