Autologous Is Superior to Allogeneic Hematopoietic Cell Transplantation for Acute Promyelocytic Leukemia in Second Complete Remission

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)...

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Bibliographic Details
Published in:Biology of blood and marrow transplantation 2014-07, Vol.20 (7), p.1021-1025
Main 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
Format: Article
Language:English
Subjects:
Adult
Allogeneic transplantation
APL
Autologous transplantation
Disease-Free Survival
Female
Hematology, Oncology and Palliative Medicine
Hematopoietic Stem Cell Transplantation - methods
Humans
Leukemia, Promyelocytic, Acute - therapy
Male
Middle Aged
Remission Induction
Retrospective Studies
Transplantation, Autologous
Transplantation, Homologous
Young Adult
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Summary: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  
ISSN:1083-8791
1523-6536
DOI:10.1016/j.bbmt.2014.03.025