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First-Line Therapy for APL: Chemotherapy-Based Approach

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Acute Promyelocytic Leukemia

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Abstract

The evolving treatment of acute promyelocytic leukemia (APL) represents one of the greatest success stories in modern medicine. Detailed understanding of the molecular pathogenesis of APL has provided a mechanistic basis for the successful clinical use of all-trans retinoic acid (ATRA) as well as arsenic trioxide (ATO) in targeting the PML/RARa fusion protein, which is pivotal in the pathogenesis of the disease. Although the advent of molecularly targeted therapy with ATRA and ATO has revolutionized the treatment of APL, the addition of conventional cytotoxic chemotherapy including anthracyclines still plays an important role, particularly in high-risk APL (white blood cell count >10,000/μL). For patients with high-risk APL who are able to tolerate cytotoxic chemotherapy, regimens used for treatment induction and consolidation include anthracyclines such as daunorubicin or idarubicin and in some treatment regimens also the pyrimidine analog cytarabine. In order to achieve the highest rates of cure, these chemotherapy agents are used in combination with ATRA ± ATO in high-risk APL. This chapter will focus on the role of first-line chemotherapy agents in combination with ATRA for APL. While clinicians may be familiar with the routine administration of conventional chemotherapy, vigilant attention must also be paid to prevent early death from specific complications in APL patients, including coagulopathy and differentiation syndrome.

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Authors and Affiliations

  1. Leukemia Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 1275 York Avenue, New York, NY, 10065, USA

    Aaron D. Goldberg M.D., Ph.D. & Martin S. Tallman M.D.

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  1. Aaron D. Goldberg M.D., Ph.D.
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  2. Martin S. Tallman M.D.
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Correspondence to Martin S. Tallman M.D. .

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Editors and Affiliations

  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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Goldberg, A.D., Tallman, M.S. (2018). First-Line Therapy for APL: Chemotherapy-Based 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_8

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