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Bone Marrow Transplant. 2015 Jan;50(1):40-4. doi: 10.1038/bmt.2014.201. Epub 2014 Sep 22.

Delayed hematopoietic recovery after auto-SCT in patients receiving arsenic trioxide-based therapy for acute promyelocytic leukemia: a multi-center analysis.

Author information

1
Division of Hematologic Malignancies and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
2
Departments of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA.
3
Department of Hematology, Fujita Health University School of Medicine, Toyoake, Japan.
4
Department of Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
5
Department of Hematology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
6
Department of Hematology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
7
Department of Clinical Laboratory Science, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.

Abstract

A potential link between arsenic (ATO)-based therapy and delayed hematopoietic recovery after autologous hematopoietic SCT (HSCT) for acute promyelocytic leukemia (APL) has previously been reported. We retrospectively reviewed the clinical histories of 58 patients undergoing autologous HSCT for APL at 21 institutions in the United States and Japan. Thirty-three (56%) of the patients received ATO-based therapy prior to stem cell collection. Delayed neutrophil engraftment occurred in 10 patients (17%): 9 of the 10 patients (90%) received prior ATO (representing 27% of all ATO-treated patients), compared with 1 of the 10 patients (10%) not previously treated with ATO (representing 4% of all ATO-naïve patients; P<0.001). Compared with ATO-naïve patients, ATO-treated patients experienced significantly longer times to ANC recovery (median 12 days vs 9 days, P<0.001). In multivariate analysis, the only significant independent predictor of delayed neutrophil engraftment was prior treatment with ATO (hazard ratio 4.87; P<0.001). Of the available stem cell aliquots from APL patients, the median viable post-thaw CD34+ cell recovery was significantly lower than that of cryopreserved autologous stem cell products from patients with non-APL AML. Our findings suggest that ATO exposure prior to CD34+ cell harvest has deleterious effects on hematopoietic recovery after autologous HSCT.

PMID:
25243620
DOI:
10.1038/bmt.2014.201
[Indexed for MEDLINE]

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