An Outcome Analysis of Childhood Acute Promyelocytic Leukemia Treated with Atra and Arsenic Trioxide, and Limited Dose Anthracycline


The overall survival of Acute Promyelocytic Leukemia (APL), reported in recent studies, is approaching to 90% wherein, arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) are used as the mainstay of treatment with either limited or no use of anthracycline and cytarabine. This study is aimed to ascertain the outcome of children with APL using similar approach. A total of 30 patients with APL, registered from January 2015 to December 2018, were reviewed. Diagnosis was established on bone marrow aspirate and confirmed by the presence of PML-RARA translocation. Treatment protocol was based on Australian APML 4 study performed by Australian Leukemia Lymphoma Group (ALLG). Lumbar puncture was not performed as it was not part of the protocol due to the risk of bleeding. The mean age in current cohort was 9 years with 53% males. Seven (23.3%) patients died and three (10%) abandoned treatment during induction. Twenty patients completed the intensive phase of chemotherapy and all (100%) of them attained molecular remission (MR). One patient dropped out after MR whereas, 19 remain on follow up with no evidence of disease, reflecting disease free survival (DFS) of 95%. With a median follow up of 2.5 years (range 2.1–4.8 years) the 5 years Kaplan–Meier estimate of OS was 63% and 73%, with and without abandonment, respectively. Analysis of outcome according to risk groups revealed inferior outcome of high risk (HR) group (38% and 50% with and without abandonment, respectively) in contrast to standard risk (SR) group which showed better outcome (82% and 88% with and without abandonment, respectively). The attainment of 100% molecular remission and absence of relapse supports the effectiveness of this regimen. Moreover, it is found to be less toxic and therefore, can be conveniently managed in day-care settings.

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Fig. 1



Acute promyelocytic leukemia


Acute myeloid leukemia


French American British


Retinoic acid receptor alpha


Promyelocytic leukemia


All-trans retinoic acid


Complete remission


Medical Research Council


The Indus hospital


Electronic medical record


Case report form


Bone marrow aspirate


World Health Organization


Fluorescence in-situ hybridization


Australian leukemia lymphoma group


White cell count


Central nervous system


Molecular remission


Polymerase chain reaction


Non-government organization


Complete blood count


Prothrombin time


Granulocyte colony stimulating factor


Statistical package for social studies


International business machines


Standard deviation


Interquartile range


Overall survival


Event free survival


Disease free survival


Early death


Low risk


High risk


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Correspondence to Naeem Jabbar.

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Jabbar, N., Khayyam, N., Arshad, U. et al. An Outcome Analysis of Childhood Acute Promyelocytic Leukemia Treated with Atra and Arsenic Trioxide, and Limited Dose Anthracycline. Indian J Hematol Blood Transfus (2021).

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  • Acute promyelocytic leukemia
  • Acute myeloid leukemia
  • Chemotherapy
  • Molecular remission
  • Survival outcome