Acute promyelocytic leukemia (APL): remaining challenges towards a cure for all

Leuk Lymphoma. 2019 Dec;60(13):3107-3115. doi: 10.1080/10428194.2019.1613540. Epub 2019 Dec 16.


The application of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) has revolutionized the treatment of acute promyelocytic leukemia (APL). More than 80-90% of patients are expected to be cured with a combination of ATRA, ATO and/or chemotherapy. In this review, we focus on the remaining obstacles to a cure for all patients with APL. We review the issue of early death and coagulopathy and discuss the particular challenges in the care of patients with high-risk APL and patients with relapsed APL. We also give recommendations and highlight ongoing efforts to improve the persistently high early death rate and the outcomes of high risk and relapsed APL patients.

Keywords: APL; ATRA; cure.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / standards
  • Arsenic Trioxide / administration & dosage
  • Arsenic Trioxide / adverse effects
  • Disease-Free Survival
  • Hemorrhage / chemically induced
  • Hemorrhage / mortality*
  • Hemorrhage / prevention & control
  • Humans
  • Incidence
  • Leukemia, Promyelocytic, Acute / drug therapy*
  • Leukemia, Promyelocytic, Acute / mortality
  • Leukemia, Promyelocytic, Acute / pathology
  • Mortality
  • Neoplasm Recurrence, Local / drug therapy*
  • Neoplasm Recurrence, Local / epidemiology
  • Practice Guidelines as Topic
  • Randomized Controlled Trials as Topic
  • Remission Induction / methods*
  • Standard of Care
  • Time Factors
  • Tretinoin / administration & dosage
  • Tretinoin / adverse effects


  • Tretinoin
  • Arsenic Trioxide