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
Department of Hematology, 1Seoul St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Yeouido St. Mary's Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Blood Res. 2022 Sep 30;57(3):197-206. doi: 10.5045/br.2022.2022060. Epub 2022 Jul 27.
Arsenic trioxide (ATO) is the standard treatment for relapsed acute promyelocytic leukemia (APL). However, consensus on post-remission therapies is still lacking.
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).
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%, =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.
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.
三氧化二砷（ATO）是复发急性早幼粒细胞白血病（APL）的标准治疗方法。然而，缓解后治疗仍缺乏共识。
我们评估了2000年至2019年在天主教血液病医院初次治疗APL后复发的52例患者。其中，41例患者接受了再诱导治疗，30例采用基于ATO的方案，而11例采用传统强化化疗（IC）。
与IC再诱导组相比，ATO再诱导组的第二次分子完全缓解（mCR2）率显著更高，中性粒细胞和血小板恢复更好，感染率更低。在基于ATO的（N = 19）、自体（N = 12）和异基因（N = 6）造血干细胞移植（HSCT）组中，缓解后治疗后的生存结果未观察到显著差异。在基于ATO的和自体HSCT组中，ATO再诱导后达到mCR2的患者中，分别有9例和5例经历了第二次复发（50.7%对41.7%，P = 0.878）。在这些患者中，7例接受了挽救性异基因HSCT；6例存活。其他7例患者未进行HSCT仅接受了ATO治疗。5例死于疾病进展，2例存活且自那时起一直处于mCR2状态。
复发APL患者缓解后治疗结果无论采用何种治疗方案均无显著差异，这表明在mCR2患者中不进行HSCT而采用基于ATO的治疗是可行的。异基因HSCT可能是第二次复发患者有效的挽救治疗方式。由于复发APL病例较少，多中心前瞻性研究可能有助于阐明每种缓解后治疗的疗效。
