All-trans-retinoic acid (ATRA) increases the efficacy of chemotherapy when used for induction and maintenance treatment of acute promyelocytic leukemia (APL), but its role in consolidation is unknown. Since November 1996, 426 patients with newly diagnosed APL have received induction therapy with ATRA and idarubicin. Before November 1999 (LPA96 study), consolidation therapy consisted of 3 courses of anthracycline monochemotherapy. After November 1999 (LPA99 study), patients with intermediate and high risks of relapse received consolidation therapy with ATRA and increased doses of anthracyclines. Of the 384 patients who achieved complete remission (90%), 382 proceeded to consolidation therapy. Seven patients died in remission (1.8%). The 3-year cumulative incidence of relapse for patients in the LPA96 and LPA99 studies was 17.2% and 7.5%, respectively (P ‫؍‬ .008). Patients treated with ATRA in consolidation therapy showed an overall reduction in the relapse rate from 20.1% to 8.7% (P ‫؍‬ .004). In intermediate-risk patients the rate decreased from 14.0% to 2.5% (P ‫؍‬ .006). This improved antileukemic efficacy also translated into significantly better disease-free and overall survival. A risk-adapted strategy combining anthracycline monochemotherapy and ATRA for induction and consolidation therapy of newly diagnosed APL results in improved antileukemic efficacy and a high degree of compliance. (Blood.

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One hundred ten patients with multiple myeloma (MM) failing to achieve at least nearcomplete remission (nCR) after a first autologous stem cell transplantation (ASCT) were scheduled to receive a second ASCT (85 patients) or a reduced-intensity-conditioning allograft (allo-RIC; 25 patients), depending on the human leukocyte antigen (HLA)-identical sibling donor availability. There was a higher increase in complete remission (CR) rate (40% vs 11%, P ‫؍‬ .001) and a trend toward a longer progression-free survival (PFS; median, 31 months vs not reached, P ‫؍‬ .08) in favor of allo-RIC. In contrast, it was associated with a trend toward a higher transplantationrelated mortality (16% vs 5%, P ‫؍‬ .07), a 66% chance of chronic graft-versus-host disease and no statistical difference in event-free survival and overall survival. Although the PFS plateau observed with allo-RIC is very encouraging, this procedure is associated with high morbidity and mortality, and therefore it should still be considered investigational and restricted to well-designed prospective clinical trials. IntroductionAutologous stem cell transplantation (ASCT) has become the standard of care in the up-front therapy for younger patients with multiple myeloma (MM). [1][2][3] In 2 randomized trials, double ASCT was superior to a single transplantation in patients failing to achieve complete remission (CR) or very good partial response after the first transplantation. 4,5 However, despite tandem ASCT, patients continue to relapse and there is no survival plateau. Allogeneic stem cell transplantation is the best potential curative approach. 6,7 However, a transplantation-related mortality (TRM) rate of 30% to 50% constitutes its major limitation. [6][7][8] The use of dose-reduced intensity conditioning (allo-RIC) has reduced the TRM to 10% to 20%. 9-15 Interestingly, promising results with autograft followed by an allo-RIC have been reported. 11,13 However, only 2 trials comparing the efficacy of double ASCT versus a single autograft followed by an allo-RIC have been published and they show contradictory results. 14,15 We report the results achieved with a second ASCT versus allo-RIC in chemosensitive patients failing to achieve CR or near-complete remission (nCR) after a first ASCT. Methods Patients and treatment planPatients diagnosed with symptomatic MM between October 1, 1999, and December 31, 2004, who were younger than 70 years were included in the Programa para el Estudio y la Terapéutica de las Hemopatías Malignas y Grupo Español de Mieloma (PETHEMA/GEM)-2000 trial. They received 6 cycles of vincristine, carmustine (BCNU), melphalan, cyclophosphamide, prednisone (VBMCP)/vincristine, BCNU, adriamycin, dexamethasone (VBAD) chemotherapy 16 followed by a first ASCT. Patients failing to achieve CR or nCR (ie, persistence of a serum or urine M-protein on the electrophoretic pattern) were scheduled to receive either a secondASCT conditioned with CVB (cyclophosphamide, etoposide, BCNU) or melphalan (MEL)-200 or an allo-RIC conditioned with fludarabine 2...

ASCT achieves long-term disease-free survival in HD patients. Disease status before ASCT is the most important prognostic factor for final outcome; thus, transplantation should be considered in early stages of the disease. TBI must be avoided in the conditioning regimen because of a significantly higher rate of late complications, including secondary malignancies.