Acute promyelocytic leukaemia (APL): chemotherapy or bone marrow transplantation?

We studied 24 patients affected by Acute Promyelocytic Leukemia (APL) treated according to the original Jean Bernard’s protocol (an induction phase with high doses of DNR, followed by a manteinance phase with MTX and 6-MP, and periodic reinduction cycles with DNR and MethylGAG). We obtained 21 CR (87.5%), while 3 patients died during the induction treatment. The 5-year mortality rate of all the patients was 46.1%; 12 patients are still alive and 9 (37.5%) relapsed at different times from the first remission. From the accurate analysis of these cases we concluded that the microgranular variant of the disease and the impossibility to perform a correct maintenance therapy are negative prognostic indexes and, ultimately, a possible indication to BMT in adult patients affected by APL