Treatment of relapsed or refractory acute promyelocytic leukemia

Martin S. Tallman*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

99 Scopus citations

Abstract

Current treatment for acute promyelocytic leukemia (APL) usually includes an induction phase with all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy, followed by a consolidation phase of anthracycline-based chemotherapy and maintenance therapy with ATRA with or without low-dose chemotherapy for 1-2 years. This treatment strategy results in a high complete remission (CR) rate of about 90% and an overall survival rate of 80%. About 5%-30% of patients relapse, mainly patients with high-risk APL. Relapse at extramedullary sites, which occurs in approximately 3%-5% of patients, is emerging as a new issue. Treatment of relapsed/advanced APL includes the use of arsenic trioxide (ATO), gemtuzumab ozogamicin, and hematopoietic stem cell transplantation. ATO is currently the most effective therapeutic agent in relapsed APL. Hematopoietic stem cell transplantation is becoming a common strategy after achieving remission with ATO. Autologous transplant appears to have a more favorable outcome than allogeneic transplant in this setting, particularly when carried out during second remission, primarily because of significantly higher treatment-related mortality with allogeneic transplants. Allogeneic transplant, however, should be strongly considered for patients who remain molecularly positive. Future directions for APL therapy should include developing agents that can prevent relapse, particularly for high-risk patients. Other future treatment strategies may include use of ATO administered concomitantly or sequentially with chemotherapy, gemtuzumab or FLT-3 inhibitors that may obviate the need for autologous transplantation, and posttransplant maintenance perhaps with FLT-3 inhibitors.

Original languageEnglish (US)
Pages (from-to)57-65
Number of pages9
JournalBest Practice and Research in Clinical Haematology
Volume20
Issue number1
DOIs
StatePublished - Mar 2007

Keywords

  • acute promyelocytic leukemia
  • allogeneic transplant
  • arsenic trioxide
  • autologous transplant
  • FLT-3
  • gemtuzumab ozogamicin
  • hematopoietic stem cell transplantation

ASJC Scopus subject areas

  • Oncology
  • Clinical Biochemistry

Fingerprint

Dive into the research topics of 'Treatment of relapsed or refractory acute promyelocytic leukemia'. Together they form a unique fingerprint.

Cite this