What is the role of bone marrow transplantation in the treatment of acute promyelocytic leukemia (APL)?

Updated: May 03, 2019
  • Author: Sandy D Kotiah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Because the cure rate for acute APL is high, bone marrow transplantation (BMT) is not the first option for these patients, but it should be offered to those with relapsed APL. [40, 41] BMT is associated with significant transplant-related mortality, especially with allogeneic transplants. Patients who achieve molecular remission with salvage therapy should be offered high-dose chemotherapy, followed by autologous stem cell transplantation (SCT) for consolidation. Patients who have persistent molecular or hematologic disease after salvage therapy should be offered allogeneic SCT if they have a good performance status and an HLA-matched donor can be found.

Other alternatives would include enrollment in a clinical trial if transplantation is not an option. Date from the Center for International Blood and Marrow Transplant Research (CIBMTR) show that the majority of patients undergo SCT in the second or subsequent remissions. Three-year overall survival (OS) was 73% for autologous SCT and 61% for allogeneic SCT.

The role of maintenance therapy after SCT has not been established. Transplantation-related mortality is improving over time with improved techniques and conditioning regimens. The role of transplantation in high-risk patients (WBC >10,000/μL) will need further investigation.


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