Curative strategies in acute promyelocytic leukemia (APL) 2008.
| Abbreviations: ATRA, all-trans retinoic acid; CNS, central nervous system; ATO, arsenic trioxide; CR, complete response; ara-C, cytosine arabinoside; PB, peripheral blood; ASCT, autologous stem cell transplantation | |
| Induction | ATRA at earliest suspicion of the disease Aggressive blood product support ATRA + anthracycline-based chemo (concurrent for high WBC and consider CNS prophylaxis); ATRA + ATO if unable to receive anthracyclines Consider CNS prophylaxis for high-risk |
| Consolidation | Anthracycline-based chemo for 2–3 cycles to molecular CR; Intermed-dose ara-C or ATO for high-risk |
| Maintenance | ATRA +/− low-dose chemo for 1–2 years; Role in molecular CR after consolidation evolving |
| Mol. monitor | RT-PCR for PML-RARα from PB every 3–6 months for 2–3 years, probably frequently for high-risk only |
| Relapse | ATO followed by ASCT (allo if PCR pos); Consider CNS prophylaxis |
| Abbreviations: ATRA, all-trans retinoic acid; CNS, central nervous system; ATO, arsenic trioxide; CR, complete response; ara-C, cytosine arabinoside; PB, peripheral blood; ASCT, autologous stem cell transplantation | |
| Induction | ATRA at earliest suspicion of the disease Aggressive blood product support ATRA + anthracycline-based chemo (concurrent for high WBC and consider CNS prophylaxis); ATRA + ATO if unable to receive anthracyclines Consider CNS prophylaxis for high-risk |
| Consolidation | Anthracycline-based chemo for 2–3 cycles to molecular CR; Intermed-dose ara-C or ATO for high-risk |
| Maintenance | ATRA +/− low-dose chemo for 1–2 years; Role in molecular CR after consolidation evolving |
| Mol. monitor | RT-PCR for PML-RARα from PB every 3–6 months for 2–3 years, probably frequently for high-risk only |
| Relapse | ATO followed by ASCT (allo if PCR pos); Consider CNS prophylaxis |