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Role of Hematopoietic Stem Cell Transplantation in Acute Promyelocytic Leukemia

The indication of hematopoietic stem cell transplantation (HSCT) in acute promyelocytic leukemia (APL) has evolved historically from a widespread use in front-line therapy during the pre-ATRA era to a virtual rejection of this indication for patients treated with modern treatments. HSCT in first com...

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Autores principales: Sanz, Jaime, Montesinos, Pau, Sanz, Miguel A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012800/
https://www.ncbi.nlm.nih.gov/pubmed/33816245
http://dx.doi.org/10.3389/fonc.2021.614215
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author Sanz, Jaime
Montesinos, Pau
Sanz, Miguel A.
author_facet Sanz, Jaime
Montesinos, Pau
Sanz, Miguel A.
author_sort Sanz, Jaime
collection PubMed
description The indication of hematopoietic stem cell transplantation (HSCT) in acute promyelocytic leukemia (APL) has evolved historically from a widespread use in front-line therapy during the pre-ATRA era to a virtual rejection of this indication for patients treated with modern treatments. HSCT in first complete remission could only be considered for an extremely small fraction of patients with persistent MRD at the end of consolidation or for those who relapse. In the pre-ATO era, relapsed patients were usually treated with readministration of ATRA and chemotherapy as salvage therapy, generally containing high-dose cytarabine and an anthracycline, followed by further post-remission chemotherapy and/or HSCT. ATO-based regimens are presently regarded as the first option for relapsed APL. The selection of the most appropriate post-remission treatment option for patients in second CR (CR2), as well as the modality of HSCT when indicated, depends on several variables, such as pre-transplant molecular status, duration of first remission, age, and donor availability. Although with a moderate level of evidence, based on recent retrospective studies, autologous HSCT would be at present the preferred option for consolidation for patients in molecular CR2. Allogeneic HSCT could be considered in patients with a very early relapse or those beyond CR2. Nevertheless, the superiority of HSCT as consolidation over other alternatives without transplantation has recently been questioned in some studies, which justify a prospective controlled study to resolve this still controversial issue.
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spelling pubmed-80128002021-04-02 Role of Hematopoietic Stem Cell Transplantation in Acute Promyelocytic Leukemia Sanz, Jaime Montesinos, Pau Sanz, Miguel A. Front Oncol Oncology The indication of hematopoietic stem cell transplantation (HSCT) in acute promyelocytic leukemia (APL) has evolved historically from a widespread use in front-line therapy during the pre-ATRA era to a virtual rejection of this indication for patients treated with modern treatments. HSCT in first complete remission could only be considered for an extremely small fraction of patients with persistent MRD at the end of consolidation or for those who relapse. In the pre-ATO era, relapsed patients were usually treated with readministration of ATRA and chemotherapy as salvage therapy, generally containing high-dose cytarabine and an anthracycline, followed by further post-remission chemotherapy and/or HSCT. ATO-based regimens are presently regarded as the first option for relapsed APL. The selection of the most appropriate post-remission treatment option for patients in second CR (CR2), as well as the modality of HSCT when indicated, depends on several variables, such as pre-transplant molecular status, duration of first remission, age, and donor availability. Although with a moderate level of evidence, based on recent retrospective studies, autologous HSCT would be at present the preferred option for consolidation for patients in molecular CR2. Allogeneic HSCT could be considered in patients with a very early relapse or those beyond CR2. Nevertheless, the superiority of HSCT as consolidation over other alternatives without transplantation has recently been questioned in some studies, which justify a prospective controlled study to resolve this still controversial issue. Frontiers Media S.A. 2021-03-18 /pmc/articles/PMC8012800/ /pubmed/33816245 http://dx.doi.org/10.3389/fonc.2021.614215 Text en Copyright © 2021 Sanz, Montesinos and Sanz http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Sanz, Jaime
Montesinos, Pau
Sanz, Miguel A.
Role of Hematopoietic Stem Cell Transplantation in Acute Promyelocytic Leukemia
title Role of Hematopoietic Stem Cell Transplantation in Acute Promyelocytic Leukemia
title_full Role of Hematopoietic Stem Cell Transplantation in Acute Promyelocytic Leukemia
title_fullStr Role of Hematopoietic Stem Cell Transplantation in Acute Promyelocytic Leukemia
title_full_unstemmed Role of Hematopoietic Stem Cell Transplantation in Acute Promyelocytic Leukemia
title_short Role of Hematopoietic Stem Cell Transplantation in Acute Promyelocytic Leukemia
title_sort role of hematopoietic stem cell transplantation in acute promyelocytic leukemia
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012800/
https://www.ncbi.nlm.nih.gov/pubmed/33816245
http://dx.doi.org/10.3389/fonc.2021.614215
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