Current recommendations for treatment of acute promyelocytic leukemia for patients not participating in a clinical trial
| Newly diagnosed patients |
| Induction6-150 |
| ATRA 45 mg/m2 per day until CR + an anthracycline, either daunorubicin 50 to 60 mg/m2 per day for 3 days or idarubicin 12 mg/m2per day every other day for 4 days. |
| Consolidation |
| One to 2 cycles of anthracycline-based chemotherapy, daunorubicin 50 to 60 mg/m2 per day for 3 days to PCR negativity, or alternatively anthracyclines/anthracenedione; idarubicin 5 mg/m2 per day on days 1 to 4 (first consolidation), mitoxantrone 10 mg/m2 per day on days 1 to 5 (second consolidation), idarubicin 12 mg/m2 on day 1 (third consolidation). High-dose cytarabine can be considered for patients who remain PCR positive after such consolidation. |
| Maintenance |
| ATRA 45 mg/m2 daily for 15 days every 3 months + 6-MP 100 mg/m2 per day + MTX 10 mg/m2 per week all for 2 years for all patients. |
| Follow-up |
| PCR for PML-RARα every 3 to 6 months for 2 years then every 6 months for 2 years. |
| Relapsed disease |
| Arsenic trioxide 0.15 mg/kg per day or Monday through Friday to second CR followed by ASCT with reinfusion molecularly negative peripheral blood stem cells or allogeneic transplantation considered in younger patients if a suitable donor is available. For patients relapsing late (> 12 months), ATRA may be used. |
| Newly diagnosed patients |
| Induction6-150 |
| ATRA 45 mg/m2 per day until CR + an anthracycline, either daunorubicin 50 to 60 mg/m2 per day for 3 days or idarubicin 12 mg/m2per day every other day for 4 days. |
| Consolidation |
| One to 2 cycles of anthracycline-based chemotherapy, daunorubicin 50 to 60 mg/m2 per day for 3 days to PCR negativity, or alternatively anthracyclines/anthracenedione; idarubicin 5 mg/m2 per day on days 1 to 4 (first consolidation), mitoxantrone 10 mg/m2 per day on days 1 to 5 (second consolidation), idarubicin 12 mg/m2 on day 1 (third consolidation). High-dose cytarabine can be considered for patients who remain PCR positive after such consolidation. |
| Maintenance |
| ATRA 45 mg/m2 daily for 15 days every 3 months + 6-MP 100 mg/m2 per day + MTX 10 mg/m2 per week all for 2 years for all patients. |
| Follow-up |
| PCR for PML-RARα every 3 to 6 months for 2 years then every 6 months for 2 years. |
| Relapsed disease |
| Arsenic trioxide 0.15 mg/kg per day or Monday through Friday to second CR followed by ASCT with reinfusion molecularly negative peripheral blood stem cells or allogeneic transplantation considered in younger patients if a suitable donor is available. For patients relapsing late (> 12 months), ATRA may be used. |
MTX indicates methotrexate.
For pediatric patients, although by an infusional schedule a dose of daunorubicin 405 mg/m2 may be exceeded, the total dose should not exceed 500 mg/m2.