Arsenic And “New Lace” – Not Just For Murderous Old Ladies!

While the standard treatment for acute promyelocytic leukemia (APL) using all-trans retinoic acid (ATRA) with chemotherapy typically results in cure rates exceeding 80%, hematologic toxicity is an issue.

In this recent phase 3 clinical trial on low to intermediate risk APL patients, ATRA plus chemotherapy was compared to ATRA plus arsenic trioxide for induction and consolidation therapy.

Complete remission was achieved in 100% of the patients in the ATRA–arsenic trioxide group and 95% of the patients in the ATRA–chemotherapy group (P=0.12).

At a median follow-up of 34.4 months, the two-year progression free survival rates (PFS) were 97% in the ATRA–arsenic trioxide group and 86% in the ATRA–chemotherapy group.

Furthermore, the overall survival rate (OS) was better with ATRA–arsenic trioxide and associated with less hematologic toxicity and fewer infections (but with more hepatic toxicity), compared with the ATRA–chemotherapy combination.

I like this approach because not only is it superior to the standard protocol, but it also produces less of the side affects that commonly prevent further treatments such as stem cell transplants.

Retinoic Acid And Arsenic Trioxide For Acute Promyelocytic Leukemia.

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