• Renzhi Pei, Junjie Cao, Junxia Ma, Pisheng Zhang, Xuhui Liu, Xiaohong Du, Dong Chen, Keya Sha, Lieguang Chen, Shuangyue Li, Jingyi Wu, Zhen Fan, Li Lin, Peipei Ye, Shanhao Tang, and Bibo Zhang.
• Department of Hematology, Yinzhou People's Hospital, 251 Baizhang Road, Ningbo, Zhejiang Province, China.
• Hematology. 2012 Nov 1;17(6):311-6.

BackgroundBoth all-trans retinoic acid (ATRA) and arsenic trioxide (As(2)O(3)) have proven to be very effective in obtaining high clinical complete remission (CR) rates in acute promyelocytic leukemia (APL).MethodsIn this study, 73 newly diagnosed APL subjects were treated with an ATRA and As(2)O(3) combination treatment in remission induction and post remission therapy. Tumor burden was examined with PCR of the PML-RAR fusion transcripts, and side effects were evaluated by means of clinical examination.ResultsThe results showed that ATRA/As(2)O(3) combination therapy yielded a CR rate of 94.5% (69/73) with a shorter time to enter CR (median: 27 days; range: 21-43 days). Four cases failed to enter CR; three of these died of cerebral hemorrhage and disseminated intravascular coagulation (DIC) within 72 hours of starting induction therapy, one older patient died of severe pulmonary infection. The early death rate was 5.5% (4/73). All 69 cases that obtained CR remained in good clinical remission after a follow-up of 35-74 months (median: 52 months).The drug toxicity profile with the use of As(2)O(3) showed mainly hepatotoxicity. Liver dysfunction was slight in most cases. There were no severe side effects in long term follow-up.ConclusionWe conclude that APL patients may benefit from the use of the combination of ATRA and As(2)O(3) in either remission induction or consolidation/maintenance.

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