Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/12156
Title: Autologous is superior to allogeneic hematopoietic cell transplantation for acute promyelocytic leukemia in second complete remission.
Authors: Holter Chakrabarty, Jennifer L;Rubinger, Morel;Le-Rademacher, Jennifer;Wang, Hai-Lin;Grigg, Andrew;Selby, George B;Szer, Jeffrey;Rowe, Jacob M;Weisdorf, Daniel J;Tallman, Martin S
Affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Oklahoma, Oklahoma City, Oklahoma. Electronic address: jholter2@ouhsc.edu.
Department of Hematology, CancerCare Manitoba, Winnipeg, Canada.
Divison of Biostatistics, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department Clinical Haematology, Austin Hospital, Melbourne, Australia.
Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Oklahoma, Oklahoma City, Oklahoma.
Department Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital City Campus, Victoria, Australia.
Department of Hematology and Oncology, Rambam Medical Center, Haifa, Israel.
Center for International Blood and Marrow Transplant Research, University of Minnesota Medical Center, Minneapolis, Minnesota.
Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Issue Date: 30-Mar-2014
Citation: Biology of Blood and Marrow Transplantation : Journal of the American Society For Blood and Marrow Transplantation 2014; 20(7): 1021-5
Abstract: To identify favored choice of transplantation in patients with acute promyelocytic leukemia (APL) in second complete remission, we studied 294 patients with APL in second complete remission (CR2) receiving allogeneic (n = 232) or autologous (n = 62) hematopoietic cell transplantation (HCT) reported to the Center for International Blood and Marrow Transplantation Research (CIBMTR) from 1995 to 2006, including 155 with pre-HCT PML/RAR∝ status (49% of allogeneic and 66% of autologous). Patient characteristics and transplantation characteristics, including treatment-related mortality, overall survival (OS), and disease-free survival, were collected and analyzed for both univariate and multivariate outcomes. With median follow-up of 115 (allogeneic) and 72 months (autologous), 5-year disease-free survival (DFS) favored autologous with 63% (49% to 75%), compared with allogeneic at 50% (44% to 57%) (P = .10). OS was 75% (63% to 85%) versus 54% (48% to 61%) (P = .002), for autologous and allogeneic transplantation, respectively. Multivariate analysis showed significantly worse DFS after allogeneic HCT (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.16 to 3.06; P = .011) and age > 40 years (HR, 2.30; 95% CI, 1.44 to 3.67; P = .0005). OS was significantly worse after allogeneic HCT (HR, 2.66; 95% CI, 1.52 to 4.65; P= .0006); age > 40 (HR, 3.29; 95% CI, 1.95 to 5.54; P < .001), and first complete remission < 12 months (HR, 1.56; 95% CI, 1.07 to 2.26; P = .021). Positive pre-HCT PML-RAR∝ status in 17 of 114 allogeneic and 6 of 41 receiving autologous transplantation did not influence relapse, treatment failure, or survival in either group. The survival advantage for autografting was attributable to increased treatment-related mortality (TRM) in the allogeneic group of 30% compared to 2% in the autologous group, in addition to the added mortality associated with GVHD. We conclude that autologous HCT yields superior OS for APL in CR2. Long-term DFS in autologous recipients, even with minimal residual disease-positive grafts, remains an important subject for further study.
Internal ID Number: 24691221
URI: http://ahro.austin.org.au/austinjspui/handle/1/12156
DOI: 10.1016/j.bbmt.2014.03.025
URL: http://www.ncbi.nlm.nih.gov/pubmed/24691221
Type: Journal Article
Subjects: APL
Allogeneic transplantation
Autologous transplantation
Adult
Disease-Free Survival
Female
Hematopoietic Stem Cell Transplantation.methods
Humans
Leukemia, Promyelocytic, Acute.therapy
Male
Middle Aged
Remission Induction
Retrospective Studies
Transplantation, Autologous
Transplantation, Homologous
Young Adult
Appears in Collections:Journal articles

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