What are the NCCN treatment guidelines for acute promyelocytic leukemia (APL)?

Updated: May 26, 2020
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Current guidelines for treatment are as follows [25] :

  • Patients with suspected APL should begin therapy with at least ATRA immediately. Do not delay therapy pending confirmatory tests because this disease is rapidly fatal. Most deaths occur due to early hemorrhage, often before treatment is initiated.
  • Patients are then stratified according to risk: Patients with a WBC less than 10 x 10 9/L are considered low risk. All others are considered high risk.
  • Low-risk patients receive ATRA 45 mg/m 2/d (in two divided doses) plus arsenic trioxide 0.15 mg/kg daily until bone marrow remission. If arsenic is contraindicated, ATRA plus idarubicin is the recommended alternative. Consolidation therapy is most often ATRA plus arsenic trioxide for 4 weeks out of 8 weeks for 4 cycles, followed by ATRA 2 weeks on, 2 weeks off for 7 cycles. Other regimens using various combinations of ATRA, arsenic trioxide, and chemotherapy are available.
  • High-risk patients receive induction therapy with ATRA plus chemotherapy (daunorubicin and cytarabine or idarubicin) with or without arsenic trioxide. Consolidation therapy consists of combinations of ATRA, arsenic trioxide, and chemotherapy.

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