HOW I TREAT NEWLY DIAGNOSED ACUTE PROMYELOCYTIC LEUKEMIA

Abstract

Acute promyelocytic leukemia (APL) represents a medical emergency with a high rate of early mortality. As a consequence, as soon as the diagnosis is suspected based upon cytologic criteria, it is necessary to start all- trans retinoic acid (ATRA) treatment without delay.  For patients with newly diagnosed APL, induction therapy with ATRA plus anthracycline based chemotherapy is recommended. At present the combination of arsenic trioxide plus ATRA should be considered for patients who are not candidates for anthracycline-based therapy. For pediatric and adult patients with APL  aged < 60 years who achieve a CR with induction, I recommend 3 intensive courses of consolidation chemotherapy associated to ATRA ,  targeted on the basis of the risk group at diagnosis. In patients treated with a very intensive consolidation chemotherapy maintenance treatment can be omitted. However If a maintenance treatment has to be adopted I suggest the use of  intermittent ATRA for 15 days every 3 months for a period of 2 years , rather than ATRA associated to chemotherapy. Moreover, taking into account the medical literature, a reduced dosage of ATRA  ( 25 mg/m²) in pediatric patients and a consolidation chemotherapy of reduced intensity in elderly patients is recommended. Furthermore,  in order to maximize survival, careful attention should be reserved to the coagulopathy and to the appearance of the differentiation syndrome . Finally,  PCR for the PML/RARA fusion gene on a bone marrow specimen every three months for two years, and then every six months for additional three years are needed during the follow-up.