What is the European LeukemiaNet induction therapy regimen for the treatment of acute promyelocytic leukemia (APL)?

Updated: Jul 02, 2019
  • Author: Sandy D Kotiah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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European LeukemiaNet regimen:

  • For low- and intermediate-risk patients, induction therapy should consist of ATRA and  arsenic trioxide  (ATO) without chemotherapy. ATRA and anthracycline-based chemotherapy is an option when ATO is contraindicated or unaffordable. 
  • For high-risk patients, treatment is with conventional ATRA plus anthracycline-based chemotherapy; ATRA plus ATO with a certain amount of chemotherapy is a possible option, but ATO is not approved for use in high-risk patients.
  • The ATRA dosage is 45 mg/m 2/day in 2 divided doses (25 mg/m 2/day in children and adolescents); the ATO dosage is 0.15 mg/kg/day IV until bone marrow remission occurs (maximum induction, 60 doses).
  • Induction therapy should not be modified based on the presence of leukemia cell characteristics that have variably been considered to predict a poorer prognosis (eg, secondary chromosomal abnormalities,  FLT3 mutations, CD56 expression, BCR3 PML-RARA isoform).
  • Treatment with ATRA should be continued until terminal differentiation of blasts and achievement of complete remission.
  • Therapy should not be modified on the basis of incomplete blast maturation (differentiation) detected up to 50 days or more after the start of treatment.

Several regimens that include chemotherapy are commonly used for induction therapy, including the European APL regimen, [1, 5, 6] the Programa para el Tratamiento de Hemopatias Malignas (PETHEMA) regimen, [7]  

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