Provocative pearls in diagnosing and treating acute promyelocytic leukemia.
The introduction of all-trans retinoic acid (ATRA) into routine clinical practice changed the outcome of acute promyelocytic leukemia (APL) from the most fatal to the most curable subtype of acute myeloid leukemia (AML). Patients who do not survive generally succumb within the first 30 days after presentation or diagnosis, often from intracranial or pulmonary hemorrhage caused by the characteristic coagulopathy associated with this disease. For the majority of patients who avoid hemorrhagic complications, the goals of decreasing the side effects of diagnosis and treatment-including pain, inpatient hospital days, and late sequelae of cytotoxic chemotherapy-have emerged as paramount. Here, we discuss novel and provocative observations regarding diagnostic and treatment strategies for APL that are likely to emerge as standards of care in the next 5 years, and that may improve the rate of early hemorrhagic death and decrease diagnosis- and treatment-related morbidity.
Memorial Sloan-Kettering Cancer Center, New York, New York 100065, USA.
Eytan M
EM
Stein
Martin S
MS
Tallman
D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle; D001853:Bone Marrow / Q000473:pathology; D002986:Clinical Trials as Topic; D003907:Dexamethasone / Q000627:therapeutic use; D042381:Granulocyte Precursor Cells / Q000473:pathology; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D010087:Oxides / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011654:Pulmonary Edema / Q000517:prevention & control; D012074:Remission Induction; D012131:Respiratory Insufficiency / Q000517:prevention & control; D014212:Tretinoin / Q000627:therapeutic use
D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D001152:Arsenicals; D010087:Oxides; D014212:Tretinoin; D003907:Dexamethasone; D000077237:Arsenic Trioxide