Managing acute promyelocytic leukemia without conventional chemotherapy: Is it possible?

ArticleinExpert Review of Hematology 4(4):427-36 · August 2011with2 Reads
DOI: 10.1586/ehm.11.42 · Source: PubMed
The introduction of all-trans retinoic acid in 1985 combined with anthracycline-based chemotherapy has revolutionized the prognosis of acute promyelocytic leukemia (APL) with current complete response rates of more than 90% and cure rates of approximately 80%. The subsequent advent of arsenic trioxide in 1994 marked an additional milestone in APL treatment and has inspired the design of rationally targeted, chemotherapy-free front-line treatment regimens without compromising the excellent outcome achieved by anthracycline-containing protocols. APL is, therefore, a unique subtype of acute myeloid leukemia potentially curable with targeted therapies without any exposure to conventional DNA-damaging chemotherapy. Cure rates of APL can be further increased by implementing management strategies to reduce early hemorrhagic deaths, which remain the major cause of treatment failure with the current therapy.
    • "Arsenic trioxide was used as a model agent here based on the reports that is causes acute vascular shutdown in solid tumors [6,19]. Moreover, ATO (TRISENOXH) is FDA approved in the United States for treatment of relapsed and refractory acute promyelocytic leukemia (APL) patients [36,37] and there are ongoing clinical trials for solid tumors including liver, brain, lung and breast cancers ( Dose limiting toxicity has been widely reported to limit potential use of ATO, but new targeted formulations have been presented [38,39]. "
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  • [Show abstract] [Hide abstract] ABSTRACT: The introduction of all-trans retinoic acid to anthracycline-based chemotherapy has revolutionized the prognosis of patients with acute promyelocytic leukemia (APL). The introduction of arsenic trioxide enabled the therapeutic approach of rationally targeted frontline protocols with minimal or no traditional cytotoxic chemotherapy and without compromise of previously established outstanding outcomes with anthracycline-based regimens. Although most of the current investigative efforts in APL are focused on developing potentially curative therapy without the exposure to toxicities and risks of DNA-disrupting agents, the cure rate can further be increased by implementing meticulous supportive care strategies that counter early coagulopathy-related deaths.
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