How is relapsed or refractory 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

Patients have resistant APL if they have not achieved complete molecular remission at the end of consolidation therapy. Individuals have relapsed disease if they achieve molecular remission, but monitoring by RT-PCR assay shows positivity on consecutive samples. This can occur in up to 30% of patients. ATO is recommended in relapsed or refractory APL. [33]

In relapsed APL, ATO shows high antileukemic activity, especially for patients who have a relapse within 1 year of receiving ATRA. Several studies in China from 1996 to 1999 showed complete remission rates of 52-96% with ATO monotherapy in relapsed APL. Soignet et al showed a complete remission rate of 85% in a multicenter study of 40 patients with APL. [34] After two cycles of ATO, 78% of patients had no evidence of the leukemic clone.

Analysis of 72 patients with APL treated with ATO alone showed a good overall survival in the good-risk group, as defined in the study, at 100% for the study period. Single-agent ATO in the management of newly diagnosed cases of low-risk APL is safe and is associated with durable responses compared with standard therapy with anthracyclines, which likely would be required in high-risk cases. [35]


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