How is low- and intermediate-risk acute promyelocytic leukemia (APL) treated?

Updated: May 03, 2019
  • Author: Sandy D Kotiah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

In patients with acute promyelocytic leukemia (APL) who are at low or intermediate risk (ie, those with a white blood cell count [WBC] of 10,000/μL or less), current guidelines from the National Comprehensive Cancer Network (NCCN) recommend all-trans-retinoic acid (ATRA), 45 mg/m2 in divided doses daily until clinical remission, plus arsenic trioxide (ATO), 0.15 mg/kg IV daily until bone marrow remission. Alternative regimens (all category 1) are as follows [14] :

  • ATRA plus daunorubicin (50 mg/m2 x 4 days or 60 mg/m2 x 3 days) and cytarabine (200 mg/m2 x 7 days)

  • ATRA plus idarubicin (12 mg/m2 on days 2, 4, 6, and 8)

  • ATRA plus ATO (0.3 mg/kg IV on days 1–5 of cycle one and 0.25 mg/kg twice weekly in weeks 2–8 or until clinical remission)

A randomized phase III study by Lo-Coco et al demonstrated that ATRA plus ATO is not inferior to ATRA plus chemotherapy for the induction therapy of patients with low- to intermediate-risk APL. The 2-year disease-free survival rate was 97% (95% confidence index [CI], 94-100%) in the ATRA–ATO group and 90% (95% CI, 84-97%) in the ATRA–chemotherapy group (P = 0.11). The 2-year cumulative incidence of relapse was 1% (95% CI, 0-4%) in the ATRA–ATO group and 6% (95% CI, 0-11%) in the ATRA–chemotherapy group (P = 0.24). [23]


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