APL0406: retinoic acid plus arsenic trioxide without chemotherapy for low- and intermediate-risk acute promyelocytic leukaemia
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.
Overview
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).
Two-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.
- Two-year event-free survival 97 percent vs 86 percent.
- Two-year overall survival 99 percent vs 91 percent.
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.
- 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.
Similar pages
not linked directly; found by shared links- Key paperNorth American Intergroup: all-trans retinoic acid in acute promyelocytic leukaemia
Shares Acute promyelocytic leukaemia, New England Journal of Medicine.
- TargetRetinoic acid receptor alpha (RARA)
- TreatmentTretinoin (all-trans retinoic acid, ATRA)
Shares APL0406, Acute promyelocytic leukaemia.
- TermDifferentiation syndrome