Abstract：
Despite therapeutic advances for acute promyelocytic leukemia (APL) with the emergence of all-trans retinoic acid, arsenic trioxide, and gemtuzumab-ozogamycin, approximately 10% of patients still experience disease relapse, typically occurring within 24 to 36 months following completion of front-line treatment. Traditionally, both allogeneic (allo) and autologous (auto) hematopoietic cell transplantation (HCT) have been considered reasonable treatment options for relapsed APL; however, no randomized controlled studies have been conducted comparing allo-HCT and auto-HCT in patients with relapsed APL. We performed a systematic review/meta-analysis to assess the totality of evidence pertaining to allo-HCT or auto-HCT in relapsed APL. Our search identified 1158 references, of which 23 met our inclusion criteria. While acknowledging the limitations of comparing these 2 treatment modalities indirectly, based on results from separate meta-analyses, it appears that pooled rates of event-free survival (71% versus 54%), progression-free survival (63% versus 43%), and overall survival (82% versus 58%) are higher after auto-HCT. This difference can be explained in part by the higher risk of pooled nonrelapse mortality (NRM) in patients undergoing allo-HCT (29% versus 5%), owing to inherent risks associated with this modality. In the absence of a randomized prospective clinical trial comparing allo-HCT and auto-HCT, our results show that both modalities are acceptable in patients with relapsed APL. The higher pooled NRM rate with allo-HCT is an important consideration when choosing this option. Additionally, the comparable pooled relapse rate for auto-HCT and allo-HCT (24% versus 23%) provides a rationale for evaluating post-HCT consolidative strategies to mitigate this risk.
摘要：
尽管随着全反式维甲酸的出现，急性早幼粒细胞白血病（APL）的治疗进展，三氧化二砷和吉妥珠单抗-奥唑霉素，大约10%的患者仍然经历疾病复发，通常发生在一线治疗完成后的24至36个月内。传统上,异基因(allo)和自体(自体)造血细胞移植(HCT)均被认为是治疗复发性APL的合理选择.然而,没有进行过比较allo-HCT与复发APL的自体HCT。我们进行了系统评价/荟萃分析（SR/MA），以评估复发性APL中与allo-HCT或auto-HCT有关的全部证据。我们的搜索确定了1,158个参考，其中23人符合我们的纳入标准。虽然承认比较的局限性，间接地,这两种治疗方式，根据单独MA的结果，似乎无事件的合并率(71%与54%），无进展(63%vs.43%），和总体(82%与58%)的生存率更高，如果开了自动HCT。这种差异可以解释，在某种程度上,由于患者接受allo-HCT时合并非复发死亡率的风险较高(29%vs.5%),由于与这种方式相关的固有风险。在没有比较allo-HCT与auto-HCT,结果表明，两种方法在复发性APL中都是可以接受的。选择此选项时，较高的合并非复发性死亡率与allo-HCT是一个重要的考虑因素。此外,可比的合并复发率(24%与23%），用于自动HCTvs.allo-HCT,分别,提供了评估HCT后合并策略以减轻此风险的基本原理。
