Treatment for relapsed acute promyelocytic leukemia

Ann Hematol. 2022 Dec;101(12):2575-2582. doi: 10.1007/s00277-022-04954-0. Epub 2022 Aug 16.


The advent of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) has significantly improved the outcomes of acute promyelocytic leukemia (APL); nevertheless, a small fraction of patients still experience relapse. Due to the infrequency of APL relapse coupled with the rapid change in the therapeutic landscape, there are limited available data regarding the treatment of relapsed APL. In this situation, however, ATO-based therapy has been shown to result in high rates of hematological and molecular complete remission (CR). Autologous hematopoietic cell transplantation (HCT) is considered the postremission therapy of choice when patients achieve molecular CR, whereas recent studies have suggested that molecular CR is not prerequisite for the success of autologous HCT. Allogeneic HCT can be reserved for selected patients, i.e., those who cannot achieve CR and those who relapse after autologous HCT, because of high toxicities and the expectation of highly favorable outcomes with autologous HCT during CR. For patients who are ineligible for HCT, prolonged administration of ATRA + ATO would be a viable option. To further refine the therapy for patients with relapsed APL, it is imperative to aggregate clinical data of patients who relapse after the ATRA + ATO frontline therapy within the framework of national and international collaboration.

Keywords: Acute promyelocytic leukemia; Allogeneic hematopoietic cell transplantation; Arsenic trioxide; Autologous hematopoietic cell transplantation; Relapse.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Arsenic Trioxide / therapeutic use
  • Arsenicals* / therapeutic use
  • Humans
  • Leukemia, Promyelocytic, Acute* / drug therapy
  • Oxides / therapeutic use
  • Recurrence
  • Treatment Outcome
  • Tretinoin / therapeutic use


  • Arsenicals
  • Oxides
  • Arsenic Trioxide
  • Tretinoin