Abstract
This chapter addresses one of the most controversial issues in the management of acute promyelocytic leukemia (APL) which is the optimal management of relapsed APL following second remission and role of hematopoietic stem cell transplantation in APL. Historical data on the outcomes with HSCT in the preoral arsenic trioxide trioxide (ATO) era will be discussed. The role of consolidation and maintenance with oral ATO-based regimens will be discussed.
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References
Niu C, Yan H, Yu T, Sun HP, Liu JX, Li XS, et al. Studies on treatment of acute promyelocytic leukemia with arsenic trioxide: remission induction, follow-up, and molecular monitoring in 11 newly diagnosed and 47 relapsed acute promyelocytic leukemia patients. Blood. 1999;94(10):3315–24.
Soignet SL, Frankel SR, Douer D, Tallman MS, Kantarjian H, Calleja E, et al. United States multicenter study of arsenic trioxide in relapsed acute promyelocytic leukemia. J Clin Oncol. 2001;19(18):3852–60.
Wang ZY, Chen Z. Acute promyelocytic leukemia: from highly fatal to highly curable. Blood. 2008;111(5):2505–15.
Sanz MA, Grimwade D, Tallman MS, Lowenberg B, Fenaux P, Estey EH, et al. Management of acute promyelocytic leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet. Blood. 2009;113(9):1875–91.
Tallman MS, Altman JK. How I treat acute promyelocytic leukemia. Blood. 2009;114(25):5126–35.
Tallman M, Douer D, Gore S, Powell BL, Ravandi F, Rowe J, et al. Treatment of patients with acute promyelocytic leukemia: a consensus statement on risk-adapted approaches to therapy. Clin Lymphoma Myeloma Leuk. 2010;10(Suppl 3):S122–6.
Douer D, Tallman MS. Arsenic trioxide: new clinical experience with an old medication in hematologic malignancies. J Clin Oncol. 2005;23(10):2396–410.
Thirugnanam R, George B, Chendamarai E, Lakshmi KM, Balasubramanian P, Viswabandya A, et al. Comparison of clinical outcomes of patients with relapsed acute promyelocytic leukemia induced with arsenic trioxide and consolidated with either an autologous stem cell transplant or an arsenic trioxide-based regimen. Biol Blood Marrow Transplant. 2009;15(11):1479–84.
Wiernik PH, De Bellis R, Muxi P, Dutcher JP. Extramedullary acute promyelocytic leukemia. Cancer. 1996;78(12):2510–4.
Breccia M, Carmosino I, Diverio D, De Santis S, De Propris MS, Romano A, et al. Early detection of meningeal localization in acute promyelocytic leukaemia patients with high presenting leucocyte count. Br J Haematol. 2003;120(2):266–70.
Vega-Ruiz A, Faderl S, Estrov Z, Pierce S, Cortes J, Kantarjian H, et al. Incidence of extramedullary disease in patients with acute promyelocytic leukemia: a single-institution experience. Int J Hematol. 2009;89(4):489–96.
Ganzel C, Douer D. Extramedullary disease in APL: a real phenomenon to contend with or not? Best Pract Res Clin Haematol. 2014;27(1):63–8.
de Botton S, Sanz MA, Chevret S, Dombret H, Martin G, Thomas X, et al. Extramedullary relapse in acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy. Leukemia. 2006;20(1):35–41.
Au WY, Kumana CR, Kou M, Mak R, Chan GC, Lam CW, et al. Oral arsenic trioxide in the treatment of relapsed acute promyelocytic leukemia. Blood. 2003;102(1):407–8.
Au WY, Li CK, Lee V, Yuen HL, Yau J, Chan GC, et al. Oral arsenic trioxide for relapsed acute promyelocytic leukemia in pediatric patients. Pediatr Blood Cancer. 2012;58(4):630–2.
Mandelli F, Labopin M, Granena A, Iriondo A, Prentice G, Bacigalupo A, et al. European survey of bone marrow transplantation in acute promyelocytic leukemia (M3). Working Party on Acute Leukemia of the European Cooperative Group for Bone Marrow Transplantation (EMBT). Bone Marrow Transplant. 1994;14(2):293–8.
Meloni G, Diverio D, Vignetti M, Avvisati G, Capria S, Petti MC, et al. Autologous bone marrow transplantation for acute promyelocytic leukemia in second remission: prognostic relevance of pretransplant minimal residual disease assessment by reverse-transcription polymerase chain reaction of the PML/RAR alpha fusion gene. Blood. 1997;90(3):1321–5.
Thomas X, Dombret H, Cordonnier C, Pigneux A, Gardin C, Guerci A, et al. Treatment of relapsing acute promyelocytic leukemia by all-trans retinoic acid therapy followed by timed sequential chemotherapy and stem cell transplantation. APL Study Group. Acute promyelocytic leukemia. Leukemia. 2000;14(6):1006–13.
Capria S, Latagliata R, Avvisati G, Breccia M, Cimino G, Diverio D, et al. BAVC regimen and autologous bone marrow transplantation for APL patients in second molecular remission: updated results. Bone Marrow Transplant. 2005;36(1):83–4.
de Botton S, Fawaz A, Chevret S, Dombret H, Thomas X, Sanz M, et al. Autologous and allogeneic stem-cell transplantation as salvage treatment of acute promyelocytic leukemia initially treated with all-trans-retinoic acid: a retrospective analysis of the European acute promyelocytic leukemia group. J Clin Oncol. 2005;23(1):120–6.
Sanz MA, Labopin M, Gorin NC, de la Rubia J, Arcese W, Meloni G, et al. Hematopoietic stem cell transplantation for adults with acute promyelocytic leukemia in the ATRA era: a survey of the European Cooperative Group for Blood and Marrow Transplantation. Bone Marrow Transplant. 2007;39(8):461–9.
Kohno A, Morishita Y, Iida H, Yanada M, Uchida T, Hamaguchi M, et al. Hematopoietic stem cell transplantation for acute promyelocytic leukemia in second or third complete remission: a retrospective analysis in the Nagoya Blood and Marrow Transplantation Group. Int J Hematol. 2008;87(2):210–6.
Linker CA, Owzar K, Powell B, Hurd D, Damon LE, Archer LE, et al. Auto-SCT for AML in second remission: CALGB study 9620. Bone Marrow Transplant. 2009;44(6):353–9.
Holter Chakrabarty JL, Rubinger M, Le-Rademacher J, Wang HL, Grigg A, Selby GB, et al. Autologous is superior to allogeneic hematopoietic cell transplantation for acute promyelocytic leukemia in second complete remission. Biol Blood Marrow Transplant. 2014;20(7):1021–5.
Pemmaraju N, Tanaka MF, Ravandi F, Lin H, Baladandayuthapani V, Rondon G, et al. Outcomes in patients with relapsed or refractory acute promyelocytic leukemia treated with or without autologous or allogeneic hematopoietic stem cell transplantation. Clin Lymphoma Myeloma Leuk. 2013;13(4):485–92.
Fujita H, Asou N, Iwanaga M, Hyo R, Nomura S, Kiyoi H, et al. Role of hematopoietic stem cell transplantation for relapsed acute promyelocytic leukemia: a retrospective analysis of JALSG-APL97. Cancer Sci. 2013;104(10):1339–45.
Yanada M, Tsuzuki M, Fujita H, Fujimaki K, Fujisawa S, Sunami K, et al. Phase 2 study of arsenic trioxide followed by autologous hematopoietic cell transplantation for relapsed acute promyelocytic leukemia. Blood. 2013;121(16):3095–102.
Ramadan SM, Di Veroli A, Camboni A, Breccia M, Iori AP, Aversa F, et al. Allogeneic stem cell transplantation for advanced acute promyelocytic leukemia in the ATRA and ATO era. Haematologica. 2012;97(11):1731–5.
Ganzel C, Mathews V, Alimoghaddam K, Ghavamzadeh A, Kuk D, Devlin S, et al. Autologous transplant remains the preferred therapy for relapsed APL in CR2. Bone Marrow Transplant. 2016;51(9):1180–3.
Gill H, Yim R, Lee HKK, Mak V, Lin SY, Kho B, et al. Long-term outcome of relapsed acute promyelocytic leukemia treated with oral arsenic trioxide-based reinduction and maintenance regimens: a 15-year prospective study. Cancer. 2018;124(11):2316–26.
Au WY, Kumana CR, Lee HK, Lin SY, Liu H, Yeung DY, et al. Oral arsenic trioxide-based maintenance regimens for first complete remission of acute promyelocytic leukemia: a 10-year follow-up study. Blood. 2011;118(25):6535–43.
Gill HS, Yim R, Kumana CR, Tse E, Kwong YL. Oral arsenic trioxide, all-trans retinoic acid, and ascorbic acid maintenance after first complete remission in acute promyelocytic leukemia: long-term results and unique prognostic indicators. Cancer. 2020;126(14):3244–54.
Shen ZX, Shi ZZ, Fang J, Gu BW, Li JM, Zhu YM, et al. All-trans retinoic acid/As2O3 combination yields a high quality remission and survival in newly diagnosed acute promyelocytic leukemia. Proc Natl Acad Sci U S A. 2004;101(15):5328–35.
Hu J, Liu YF, Wu CF, Xu F, Shen ZX, Zhu YM, et al. Long-term efficacy and safety of all-trans retinoic acid/arsenic trioxide-based therapy in newly diagnosed acute promyelocytic leukemia. Proc Natl Acad Sci U S A. 2009;106(9):3342–7.
Iland HJ, Bradstock K, Supple SG, Catalano A, Collins M, Hertzberg M, et al. All-trans-retinoic acid, idarubicin, and IV arsenic trioxide as initial therapy in acute promyelocytic leukemia (APML4). Blood. 2012;120(8):1570–80. quiz 752
Lo-Coco F, Avvisati G, Vignetti M, Thiede C, Orlando SM, Iacobelli S, et al. Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med. 2013;369(2):111–21.
Song X, Hu X, Lu S, Gao L, Chen L, Yang J, et al. Incorporation of arsenic trioxide in induction therapy improves survival of patients with newly diagnosed acute promyelocytic leukaemia. Eur J Haematol. 2014;93(1):54–62.
Abaza Y, Kantarjian H, Garcia-Manero G, Estey E, Borthakur G, Jabbour E, et al. Long-term outcome of acute promyelocytic leukemia treated with all-trans-retinoic acid, arsenic trioxide, and gemtuzumab. Blood. 2017;129(10):1275–83.
Burnett AK, Russell NH, Hills RK, Bowen D, Kell J, Knapper S, et al. Arsenic trioxide and all-trans retinoic acid treatment for acute promyelocytic leukaemia in all risk groups (AML17): results of a randomised, controlled, phase 3 trial. Lancet Oncol. 2015;16(13):1295–305.
Specchia G, Lo Coco F, Vignetti M, Avvisati G, Fazi P, Albano F, et al. Extramedullary involvement at relapse in acute promyelocytic leukemia patients treated or not with all-trans retinoic acid: a report by the Gruppo Italiano Malattie Ematologiche dell'Adulto. J Clin Oncol. 2001;19(20):4023–8.
Montesinos P, Diaz-Mediavilla J, Deben G, Prates V, Tormo M, Rubio V, et al. Central nervous system involvement at first relapse in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline monochemotherapy without intrathecal prophylaxis. Haematologica. 2009;94(9):1242–9.
Lengfelder E, Lo-Coco F, Ades L, Montesinos P, Grimwade D, Kishore B, et al. Arsenic trioxide-based therapy of relapsed acute promyelocytic leukemia: registry results from the European LeukemiaNet. Leukemia. 2015;29(5):1084–91.
Ko BS, Tang JL, Chen YC, Yao M, Wang CH, Shen MC, et al. Extramedullary relapse after all-trans retinoic acid treatment in acute promyelocytic leukemia--the occurrence of retinoic acid syndrome is a risk factor. Leukemia. 1999;13(9):1406–8.
Sanz MA, Lo Coco F, Martin G, Avvisati G, Rayon C, Barbui T, et al. Definition of relapse risk and role of nonanthracycline drugs for consolidation in patients with acute promyelocytic leukemia: a joint study of the PETHEMA and GIMEMA cooperative groups. Blood. 2000;96(4):1247–53.
Guglielmi C, Martelli MP, Diverio D, Fenu S, Vegna ML, Cantu-Rajnoldi A, et al. Immunophenotype of adult and childhood acute promyelocytic leukaemia: correlation with morphology, type of PML gene breakpoint and clinical outcome. A cooperative Italian study on 196 cases. Br J Haematol. 1998;102(4):1035–41.
Gonzalez M, Barragan E, Bolufer P, Chillon C, Colomer D, Borstein R, et al. Pretreatment characteristics and clinical outcome of acute promyelocytic leukaemia patients according to the PML-RAR alpha isoforms: a study of the PETHEMA group. Br J Haematol. 2001;114(1):99–103.
Mathews V, George B, Chendamarai E, Lakshmi KM, Desire S, Balasubramanian P, et al. Single-agent arsenic trioxide in the treatment of newly diagnosed acute promyelocytic leukemia: long-term follow-up data. J Clin Oncol. 2010;28(24):3866–71.
Ravandi F, Estey E, Jones D, Faderl S, O'Brien S, Fiorentino J, et al. Effective treatment of acute promyelocytic leukemia with all-trans-retinoic acid, arsenic trioxide, and gemtuzumab ozogamicin. J Clin Oncol. 2009;27(4):504–10.
Takeshita A, Shinjo K, Naito K, Matsui H, Sahara N, Shigeno K, et al. Efficacy of gemtuzumab ozogamicin on ATRA- and arsenic-resistant acute promyelocytic leukemia (APL) cells. Leukemia. 2005;19(8):1306–11.
Lo-Coco F, Cimino G, Breccia M, Noguera NI, Diverio D, Finolezzi E, et al. Gemtuzumab ozogamicin (Mylotarg) as a single agent for molecularly relapsed acute promyelocytic leukemia. Blood. 2004;104(7):1995–9.
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Gill, H. (2023). Management of Relapsed Acute Promyelocytic Leukemia and the Role of Hematopoietic Stem Cell Transplantation. In: Gill, H., Kwong, YL. (eds) Pathogenesis and Treatment of Leukemia. Springer, Singapore. https://doi.org/10.1007/978-981-99-3810-0_18
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DOI: https://doi.org/10.1007/978-981-99-3810-0_18
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