Treatment of Acute Promyelocytic Leukemia
Open Access
- 1 January 2006
- journal article
- review article
- Published by American Society of Hematology in Hematology-American Society Hematology Education Program
- Vol. 2006 (1), 147-155
- https://doi.org/10.1182/asheducation-2006.1.147
Abstract
Cure of acute promyelocytic leukemia (APL) is now a possibility for most patients through the use of state-of-the-art treatments, which include simultaneous administration of all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy for induction and consolidation, as well as ATRA-based maintenance. Risk-adapted strategies to modulate treatment intensity may be an effective approach to minimize therapy-related morbidity and mortality while maintaining the potential of cure. In this context, there is no role for hematopoietic stem cell transplantation (HSCT) in front-line therapy, except for the small fraction of patients with persistent minimal residual disease at the end of consolidation. However, HSCT plays an important role for patients in second complete remission. In contrast, an increasing role of arsenic trioxide (ATO) is emerging. Given the high antileukemic efficacy observed with ATO in patients relapsing after ATRA-containing regimens, this agent is currently regarded as the best treatment option in this setting. However, until a randomized comparison between the standard therapy and ATO-based regimens in front-line therapy is available, this latter approach should only be recommended for unfit patients for whom chemotherapy is contraindicated. In addition to reviewing current consensus and controversial issues on antileukemic strategies, this review addresses other aspects that can be crucial for the outcome of individual patients. These aspects include supportive care, recognition and treatment of life-threatening complications, evaluation of response, and, finally, management of the disease in special conditions such as older patients, children and pregnant women.Keywords
This publication has 34 references indexed in Scilit:
- ATO: the forefront of APL treatment?Blood, 2006
- Choice of chemotherapy in induction, consolidation and maintenance in acute promyelocytic leukaemiaBest Practice & Research Clinical Haematology, 2003
- Induction therapy with idarubicin alone significantly influences event-free survival duration in patients with newly diagnosed hypergranular acute promyelocytic leukemia: final results of the GIMEMA randomized study LAP 0389 with 7 years of minimal follow-upBlood, 2002
- Acute promyelocytic leukemia: evolving therapeutic strategiesBlood, 2002
- A Randomized Comparison of All Transretinoic Acid (ATRA) Followed by Chemotherapy and ATRA Plus Chemotherapy and the Role of Maintenance Therapy in Newly Diagnosed Acute Promyelocytic LeukemiaBlood, 1999
- Analysis of prognostic factors in newly diagnosed acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy. Japan Adult Leukemia Study Group.Journal of Clinical Oncology, 1998
- All-trans-Retinoic Acid in Acute Promyelocytic LeukemiaNew England Journal of Medicine, 1997
- Effect of all transretinoic acid in newly diagnosed acute promyelocytic leukemia. Results of a multicenter randomized trial. European APL 91 GroupBlood, 1993
- Use of all-trans retinoic acid in the treatment of acute promyelocytic leukemiaBlood, 1988
- Acute Promyelocytc LeukemiaActa Medica Scandinavica, 1957