Comparative analysis of allogeneic hematopoietic cell transplantation in patients with therapy-related and de novo acute promyelocytic leukemia A retrospective study

Although allogeneic hematopoietic cell transplantation (HCT) is an alternative treatment for relapsed or refractory (R/R) acute promyelocytic leukemia (APL), little is known regarding the utility of allogeneic HCT for R/R therapy-related APL (t-APL). We retrospectively analyzed data for 144 patients with APL (t-APL, n = 20 and de novo APL, n = 124) who received a first allogeneic HCT between 2008 and 2020. We found no significant differences in survival between the t-APL and de novo APL groups. The 3-year overall survival (OS) rates were 53.8% in the t-APL group and 52.4% in the de novo APL group. However, as previously reported, patients without complete remission (CR) at HCT had significantly worse OS than those with CR (P = 0.004). The 3-year OS rates were 61.1% in patients with CR and 36.5% in those without CR. These findings suggest that allogeneic HCT may be considered a viable treatment option for patients with t-APL and de novo APL, with an emphasis on achieving CR before transplantation to optimize outcomes. However, clinicians should be aware of the potential for worse outcomes in male patients and those with lower performance status, highlighting the need for personalized treatment approaches and careful patient selection.