J Korean Cancer Assoc.  1999 Apr;31(2):331-338.

Autologous or Allogeneic Bone Marrow Transplantation Compared with Consolidation Chemotherapy in Acute promyelocytic Leukemia

• Min CK
• Min WS
• Kim HJ
• Eom HS
• Lee JW
• Han K
• Choi IB
• Kim CC
• Kim WI
• Kim DJ

Abstract

PURPOSE: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myelogenous leukemia characterized by the morphology of blast cells (M3 in FAB classification), the t (15;17) translocation, and a coagulopathy combining disseminated intravascular coagulation and fibrinolysis. It has been considered to have better response to combination chemo- therapy of an anthracycline and cytosine arabinoside and a higher cure rate than other subtypes because of recent approach of differentiating leukemic blasts by all-transretinoic acid (ATRA). The role of stem cell transplantation in APL has to be determined in comparison with that of consolidation chemotherapy.
MATERIALS AND METHODS
We compared the leukemia-free survival and overall survival between APL patients receiving the consolidation chemotherapy and those undergoing the allogeneic or autologous stem cell transplantation following the high-dose anticancer therapy. Of the 65 patients achieving the first complete remission from 1992 to 1997, 33 patients were treated with 3 courses of consolidation chemotherapies and 32 with the stem cell transplantation.
RESULTS
With a median follow-up of 22 months (8-60), the actuarial leukemia-free survival at 3 years was significantly higher in transplantation group than in chematherapy group (73.8% versus 33.5%; P=0.0087), and the probability of leukemic relapse was considerably lower in transplantation group than in chemotherapy group (6.3% versus 57.5%; P=0.001). The treatment-related mortalities of the groups were 0% in chemotherapy group and 14.3% in transplantation group. The main cause of deaths was relapse in the consolidation chemotherapy group.
CONCLUSION
These data demonstrate that the stem cell transplantation results in better leukemia-free survival than the consolidation chemotherapy for patients with APL in the first complete remission because of lower risk of relapse.

Keyword

Acute promyelocytic leukemia; Consolidation chemotherapy; Bone marrow transplantation

MeSH Terms

Bone Marrow Transplantation*
Bone Marrow*
Cause of Death
Consolidation Chemotherapy*
Cytarabine
Disseminated Intravascular Coagulation
Drug Therapy
Fibrinolysis
Follow-Up Studies
Humans
Leukemia, Myeloid, Acute
Leukemia, Promyelocytic, Acute*
Mortality
Recurrence
Stem Cell Transplantation
Cytarabine