Have all-trans retinoic acid and arsenic trioxide replaced all-trans retinoic acid and anthracyclines in APL as standard of care.

Harry J Iland, Andrew Wei, John F Seymour

Journal: Best practice & research. Clinical haematology 2015;27(1):39-52

PMID: 24907016

Full Text on Elsevier Science View on PubMed

Abstract

Until recently, the standard of care in the treatment of APL has involved the combination of all-trans retinoic acid with anthracycline-based chemotherapy during both induction and consolidation. Additionally, the intensity of consolidation chemotherapy has evolved according to a universally accepted relapse-risk stratification algorithm based on the white cell and platelet counts at presentation. That standard of care is being challenged by the increasing incorporation of arsenic trioxide into front-line treatment protocols, based on two complementary observations. The first is the undoubted anti-leukaemic activity of arsenic trioxide as shown in the relapsed and refractory setting, and in the initial management of low- and intermediate-risk patients. The second is an improved understanding of the action of both all-trans retinoic acid and arsenic trioxide in mediating APL cell eradication, with increasing recognition that PML-RARA fusion protein degradation rather than direct induction of terminal differentiation is the primary mechanism for their ability to eliminate leukaemia initiating cells. As a result, we believe the standard of care for initial therapy in APL is shifting towards an all-trans retinoic acid plus arsenic trioxide-based approach, with additional chemotherapy reserved for patients with high-risk disease.

Address: Institute of Haematology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; University of Sydney, Sydney, NSW 2006, Australia. Electronic address: [email protected].; Department of Haematology, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia; Monash University, Melbourne, VIC, Australia. Electronic address: [email protected].; Peter MacCallum Cancer Centre, 7, St. Andrews Place, East Melbourne, VIC 3002, Australia; University of Melbourne, Melbourne, VIC 3010, Australia. Electronic address: [email protected].

DOI: 10.1016/j.beha.2014.04.003

Link outs

Free resources

Other Literature Sources:

https://scite.ai/reports/24907016

Research Materials:

https://antibodies.cancer.gov/detail/CPTC-HLA-B-1

Subscription / membership required

Full Text Sources:

MeSH Terms: Adult, Age Factors, Aged, Anthracyclines, Antineoplastic Agents, Antineoplastic Combined Chemotherapy Protocols, Arsenic Trioxide, Arsenicals, Blood Coagulation Factors, Clinical Trials as Topic, Combined Modality Therapy, Cytarabine, Etoposide, Humans, Hydroxyurea, Idarubicin, Leukemia, Promyelocytic, Acute, Maintenance Chemotherapy, Middle Aged, Mitoxantrone, Multicenter Studies as Topic, Oxides, Platelet Transfusion, Practice Guidelines as Topic, Remission Induction, Risk Assessment, Thioguanine, Treatment Outcome, Tretinoin