{"entity":{"id":"paper-apl0406-lo-coco-nejm-2013","kind":"paper","name":"APL0406: retinoic acid plus arsenic trioxide without chemotherapy for low- and intermediate-risk acute promyelocytic leukaemia","aka":[],"tldr":"Combining all-trans retinoic acid with arsenic trioxide cured almost every patient with lower-risk acute promyelocytic leukaemia without any conventional chemotherapy, and did so with fewer complications than the chemotherapy-based standard.","summary":"Phase 3 non-inferiority trial of 162 patients with non-high-risk APL randomised to all-trans retinoic acid plus arsenic trioxide or to retinoic acid plus idarubicin chemotherapy (AIDA).\n\nTwo-year event-free survival was 97 percent with the chemotherapy-free regimen against 86 percent with AIDA, and overall survival 99 versus 91 percent; the arsenic arm had less haematological toxicity and fewer infections but more liver enzyme rises and QT prolongation.","asOf":"2026-09-17","links":[{"label":"N Engl J Med 2013","url":"https://doi.org/10.1056/NEJMoa1300874"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/23841729/"}],"tags":[],"related":[],"cancers":["apl"],"sections":[],"technologies":[],"targets":[],"drugs":["arsenic-trioxide"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["apl0406"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2013,"doi":"10.1056/NEJMoa1300874","pmid":"23841729","authors":"Lo-Coco F, Avvisati G, Vignetti M, et al.","paperType":"rct","findings":["Two-year event-free survival 97 percent vs 86 percent.","Two-year overall survival 99 percent vs 91 percent."],"whatItMeans":"Low- and intermediate-risk APL is now treated without cytotoxic chemotherapy. The regimen has become the standard worldwide and made APL the most curable adult acute leukaemia.","caveats":["High-risk patients (white count over 10,000) were excluded and still receive added chemotherapy or gemtuzumab.","Differentiation syndrome remains a risk with either regimen."],"changedPractice":true,"participants":162},"route":"/key-papers/paper-apl0406-lo-coco-nejm-2013/","neighbours":{"cancer":[{"id":"apl","kind":"cancer","name":"Acute promyelocytic leukaemia","route":"/cancers/apl/"}],"drug":[{"id":"arsenic-trioxide","kind":"drug","name":"Arsenic trioxide","route":"/drugs/arsenic-trioxide/"}],"trial":[{"id":"apl0406","kind":"trial","name":"APL0406","route":"/trials/apl0406/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}