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

  • Harry Iland
Chapter

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.

Keywords

All-trans retinoic acid (ATRA) Arsenic trioxide (ATO) Anthracycline Cardiotoxicity Differentiation syndrome 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Haematology, Royal Prince Alfred HospitalCamperdownAustralia

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