Management of relapse
| Recommendation . | Level of evidence . | Grade of recommendation . |
|---|---|---|
| 4.1. For patients with confirmed molecular relapse (defined as 2 successive PCR-positive assays, with stable or rising PML-RARA transcript levels detected in independent samples analyzed in 2 laboratories) preemptive therapy has to be started promptly to prevent frank relapse. | IIa | B |
| 4.2. Although ATRA in combination with chemotherapy can be used as salvage therapy, ATO-based regimens are presently regarded the first option for treatment of relapsed APL. | IV | C |
| 4.3. Patients achieving second CR should receive intensification with SCT or chemotherapy, if possible. | IV | C |
| 4.4. Allogeneic HSCT is recommended for patients failing to achieve a second molecular remission. | IV | C |
| 4.5. Autologous HSCT is a valid option for patients without detectable MRD in the marrow and with an adequate PCR negative harvest. | IIa | B |
| 4.6. For patients in whom HSCT is not feasible, the available options include repeated cycles of ATO with or without ATRA with or without chemotherapy. | IV | C |
| 4.7. For patients with CNS relapse, induction treatment consists of weekly triple intrathecal therapy (ITT) with methotrexate, hydrocortisone, and cytarabine until complete clearance of blasts in the cerebrospinal fluid, followed by 6 to 10 more spaced out ITT treatments as consolidation. Systemic treatment should also be given. | IV | C |
| Recommendation . | Level of evidence . | Grade of recommendation . |
|---|---|---|
| 4.1. For patients with confirmed molecular relapse (defined as 2 successive PCR-positive assays, with stable or rising PML-RARA transcript levels detected in independent samples analyzed in 2 laboratories) preemptive therapy has to be started promptly to prevent frank relapse. | IIa | B |
| 4.2. Although ATRA in combination with chemotherapy can be used as salvage therapy, ATO-based regimens are presently regarded the first option for treatment of relapsed APL. | IV | C |
| 4.3. Patients achieving second CR should receive intensification with SCT or chemotherapy, if possible. | IV | C |
| 4.4. Allogeneic HSCT is recommended for patients failing to achieve a second molecular remission. | IV | C |
| 4.5. Autologous HSCT is a valid option for patients without detectable MRD in the marrow and with an adequate PCR negative harvest. | IIa | B |
| 4.6. For patients in whom HSCT is not feasible, the available options include repeated cycles of ATO with or without ATRA with or without chemotherapy. | IV | C |
| 4.7. For patients with CNS relapse, induction treatment consists of weekly triple intrathecal therapy (ITT) with methotrexate, hydrocortisone, and cytarabine until complete clearance of blasts in the cerebrospinal fluid, followed by 6 to 10 more spaced out ITT treatments as consolidation. Systemic treatment should also be given. | IV | C |