Current recommendations for treatment of APL for patients not participating in a clinical trial.
| Abbreviations: ATRA, all-trans retinoic acid; 6-MP, 6-mercaptopurine; MTX, methotrexate; PCR, polymerase chain reaction; PML-RARα, promyelocytic-retinoic acid receptor-alpha; PBSCs, peripheral blood stem cells; CR, clinical remission; ASCT, autologous stem cell transplantation; PBSC, peripheral blood stem cells |
| Newly Diagnosed Patients |
| Induction† |
| ATRA 45 mg/m2/day until CR + an anthracycline, either daunorubicin 50–60 mg/m2/day for 3 days or idarubicin 12 mg/m2/day every other day for 4 days, although other schedules may be as effective. |
| Consolidation |
| 2–3 cycles of anthracycline-based chemotherapy, or high-dose cytarabine can be considered for patients who remain PCR positive after such consolidation, or allogeneic stem cell transplantation or ASCT with previously harvested molecularly negative cells. |
| Maintenance |
| ATRA 45 mg/m2 daily for 15 days every 3 months + 6-MP 100 mg/m2/day + MTX 10 mg/m2/week all for 2 years for all patients. |
| Follow-up and Molecular Monitoring |
| PCR for PML-RARα every 3–6 months for 2 years then every 6 months for 2 years |
| Relapsed Disease |
| Arsenic trioxide 0.15 mg/kg/day or Monday–Friday, to second CR followed by ASCT with reinfusion molecularly-negative PBSCs or allogeneic transplant considered in younger patients if a suitable donor is available. Allogeneic transplant should be considered in patients who remain molecularly positive. |
| † For pediatric patients, although by an infusional schedule, a dose of daunorubicin of 405 mg/m2 may be exceeded, the total dose should not exceed 500 mg/m2. |
| Abbreviations: ATRA, all-trans retinoic acid; 6-MP, 6-mercaptopurine; MTX, methotrexate; PCR, polymerase chain reaction; PML-RARα, promyelocytic-retinoic acid receptor-alpha; PBSCs, peripheral blood stem cells; CR, clinical remission; ASCT, autologous stem cell transplantation; PBSC, peripheral blood stem cells |
| Newly Diagnosed Patients |
| Induction† |
| ATRA 45 mg/m2/day until CR + an anthracycline, either daunorubicin 50–60 mg/m2/day for 3 days or idarubicin 12 mg/m2/day every other day for 4 days, although other schedules may be as effective. |
| Consolidation |
| 2–3 cycles of anthracycline-based chemotherapy, or high-dose cytarabine can be considered for patients who remain PCR positive after such consolidation, or allogeneic stem cell transplantation or ASCT with previously harvested molecularly negative cells. |
| Maintenance |
| ATRA 45 mg/m2 daily for 15 days every 3 months + 6-MP 100 mg/m2/day + MTX 10 mg/m2/week all for 2 years for all patients. |
| Follow-up and Molecular Monitoring |
| PCR for PML-RARα every 3–6 months for 2 years then every 6 months for 2 years |
| Relapsed Disease |
| Arsenic trioxide 0.15 mg/kg/day or Monday–Friday, to second CR followed by ASCT with reinfusion molecularly-negative PBSCs or allogeneic transplant considered in younger patients if a suitable donor is available. Allogeneic transplant should be considered in patients who remain molecularly positive. |
| † For pediatric patients, although by an infusional schedule, a dose of daunorubicin of 405 mg/m2 may be exceeded, the total dose should not exceed 500 mg/m2. |