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Acute Promyelocytic Leukemia pp 113–132Cite as

First-Line Therapy: ATRA-ATO/Reduced Chemotherapy Approach

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Abstract

The dramatic improvement in the outcome of patients with acute promyelocytic leukemia can be traced to several factors. The problem of early hemorrhagic death has been partially ameliorated by the judicious use of platelet transfusions and plasma products. Similarly, death due to differentiation syndrome appears less problematic since the introduction of prophylactic corticosteroids, although objective evidence for this is lacking. The other major cause of failure, relapse following attainment of complete remission, has progressively declined following the introduction of all-trans retinoic acid (ATRA), the adoption of risk-adapted chemotherapy in consolidation, and more recently the incorporation of arsenic trioxide (ATO) into frontline treatment protocols. Unfortunately, the benefits of chemotherapy intensification have been compromised to some extent by the regrettable occurrence of deaths in remission and by the development of anthracycline-related cardiomyopathy and therapy-related myeloid neoplasms. The combination of ATRA and ATO without chemotherapy has proven to be superior to chemotherapy-based regimens for the majority of patients, but inclusion of some anthracycline is still required for patients with the highest risk of failure. This chapter will focus on those patients most likely to benefit from an ATRA-ATO/reduced chemotherapy approach.

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Authors and Affiliations

  1. Institute of Haematology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia

    Harry Iland M.B.B.S., F.R.A.C.P., F.R.C.P.A.

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  1. Harry Iland M.B.B.S., F.R.A.C.P., F.R.C.P.A.
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Correspondence to Harry Iland M.B.B.S., F.R.A.C.P., F.R.C.P.A. .

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  1. Division of Hematology/Oncology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada

    Oussama Abla

  2. Department of Hematology, University of Tor Vergata, Rome, Italy

    Francesco Lo Coco

  3. Department of Medicine, Hospital Universitari i Politecnic La Fe, University of Valencia, Valencia, Spain

    Miguel A. Sanz

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Iland, H. (2018). First-Line Therapy: ATRA-ATO/Reduced Chemotherapy Approach. In: Abla, O., Lo Coco, F., Sanz, M. (eds) Acute Promyelocytic Leukemia . Springer, Cham. https://doi.org/10.1007/978-3-319-64257-4_9

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