Acute promyelocytic leukemia

Acute promyelocytic leukemia (APL), associated with the t(15;17) translocation has the most favorable prognosis of the AMLs, with long-term remission rates of approximately 80% with ATRA-based induction strategies.109 Nonetheless, relapses occur and frequently involve the CNS.110 Fortunately, reinduction with arsenic-based regimens is often successful at inducing second remissions.111 As consolidative therapy for APL in second remission, both autologous and allogeneic transplant approaches have been attempted. Meloni et al. demonstrated the value of PCR testing for minimal residual disease in a series of patients who underwent autologous transplantation for APL in second clinical remission. Patients with detectable translocations between the PML and RAR a genes all relapsed, while the in patients without minimal residual disease by PCR relapsed rarely.112 In a series of patients with APL in second clinical remission who received allogeneic stem cell transplants from HLA-identical siblings, long-term disease-free survival was 46%.113 Sustained remissions were noted even in patients with persistent minimal residual disease prior to transplantation. This suggests that an active GVL effect can cure APL, when autologous transplantation is not indicated. While autologous or allogeneic transplantation are generally only indicated for patients with APL in first remission when standard therapy cannot be administered, patients in second remission benefit from autologous transplantation, when minimal residual disease is undetectable or allogeneic transplantation when minimal residual disease persists.

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