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Acute Myeloid Leukemia

Management of patients with acute promyelocytic leukemia

Leukemia volume 32, pages 1277–1294 (2018)Cite this article

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Abstract

With the introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) acute promyelocytic leukemia (APL) has become from a detrimental to one of the most curable malignant diseases in humans. In particular, the chemotherapy-free regimen with ATO/ATRA has been proven to be highly effective in de novo APL and has become standard first-line therapy in younger adult, non-high-risk patients. Nevertheless, early death is still a major issue in APL, particularly in older patients, emphasizing the need of rapid diagnostics and supportive care together with immediate access to ATRA-based therapy. Despite the dramatic progress achieved in therapy of APL challenging situations occur, particularly in patients excluded from controlled studies with clinical knowledge mainly based on case reports and registries. Rapid identification and treatment of newly diagnosed patients as well as the management of toxicities and complications remain challenging. We offer up-to-date information and guidance regarding treatment of APL. Based on a literature review of existing scientific evidence we also discuss the approach to high-risk, elderly, pregnant and pediatric patients, treatment in patients with renal failure as well as of therapy-related or relapsed/refractory APL.

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Acknowledgements

SK gratefully acknowledges to be supported by the Olympia-Morata program from the Medical Faculty of the Heidelberg University. UP was supported by a grant from the Deutsche Forschungsgemeinschaft (DFG SFB-655).

Author contributions

SK, RFS, and UP were responsible for the concept of this review, contributed to the literature search data collection, analyzed and interpreted data, and wrote the manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany

    Sabine Kayser

  2. Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany

    Sabine Kayser

  3. NCT Trial Center, National Center for Tumor Diseases, Heidelberg, Germany

    Richard F. Schlenk

  4. Medical Clinic I, University Hospital Carl-Gustav-Carus, Dresden, Germany

    Uwe Platzbecker

  5. German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany

    Uwe Platzbecker

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  1. Sabine Kayser
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Correspondence to Uwe Platzbecker.

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UP has received research support from TEVA. All other authors declare that they have no conflict of interest.

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Kayser, S., Schlenk, R.F. & Platzbecker, U. Management of patients with acute promyelocytic leukemia. Leukemia 32, 1277–1294 (2018). https://doi.org/10.1038/s41375-018-0139-4

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