Acute Promyelocytic Leukemia: Where Did We Start, Where Are We Now, and the Future

Blood Cancer J. 2015 Apr 17;5(4):e304. doi: 10.1038/bcj.2015.25.

Abstract

Historically, acute promyelocytic leukemia (APL) was considered to be one of the most fatal forms of acute leukemia with poor outcomes before the introduction of the vitamin A derivative all-trans retinoic acid (ATRA). With considerable advances in therapy, including the introduction of ATRA initially as a single agent and then in combination with anthracyclines, and more recently by development of arsenic trioxide (ATO)-containing regimens, APL is now characterized by complete remission rates of 90% and cure rates of ∼80%, even higher among low-risk patients. Furthermore, with ATRA-ATO combinations, chemotherapy may safely be omitted in low-risk patients. The disease is now considered to be the most curable subtype of acute myeloid leukemia (AML) in adults. Nevertheless, APL remains associated with a significant incidence of early death related to the characteristic bleeding diathesis. Early death, rather than resistant disease so common in all other subtypes of AML, has emerged as the major cause of treatment failure.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anthracyclines / adverse effects
  • Anthracyclines / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols
  • Arsenic Trioxide
  • Arsenicals / adverse effects
  • Arsenicals / therapeutic use*
  • Drug-Related Side Effects and Adverse Reactions
  • Humans
  • Leukemia, Promyelocytic, Acute / drug therapy*
  • Leukemia, Promyelocytic, Acute / epidemiology
  • Leukemia, Promyelocytic, Acute / pathology
  • Oxides / adverse effects
  • Oxides / therapeutic use*
  • Treatment Failure
  • Tretinoin / adverse effects
  • Tretinoin / therapeutic use*

Substances

  • Anthracyclines
  • Arsenicals
  • Oxides
  • Tretinoin
  • Arsenic Trioxide