What are the NCCN guidelines on the treatment of high-risk acute promyelocytic leukemia (APL)?

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

In patients who are at high risk and able to tolerate anthracyclines, NCCN recommends a choice of the following regimens [14] :

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

  • ATRA plus age-adjusted idarubicin (6–12 mg/m2 on days 2, 4, 6, 8) and ATO (0.15 mg/kg on days 9–36 as 2 h IV infusion) 

  • ATRA plus daunorubicin (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, 8)

At count recovery, consider lumbar puncture and proceed to consolidation therapy. [14]

In patients who are at high risk and unable to tolerate anthracyclines, the NCCN recommends ATRA plus ATO. Induction is continued until count recovery and bone marrow remission are demonstrated. [14]


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