title: Long term curative effects of sequential therapy with all-trans retinoic acid, arsenious oxide and chemotherapy on patients with acute promyelocytic leukemia.
abstract: BACKGROUND
  Both all-trans retinoic acid (ATRA) and arsenic trioxide (As(2)O(3)) have proven to be very effective in obtaining high clinical complete remission (CR) rates in acute promyelocytic leukemia (APL).
  
  
  METHODS
  In this study, 73  newly diagnosed APL subjects were treated with an ATRA and As(2)O(3) combination treatment in remission induction and post remission therapy. Tumor burden was examined with PCR of the PML-RAR fusion transcripts, and side effects were evaluated by means of clinical examination.
  
  
  RESULTS
  The results showed that ATRA/As(2)O(3) combination therapy yielded a CR rate of 94.5% (69/73) with a shorter time to enter CR (median: 27 days; range: 21-43 days). Four cases failed to enter CR; three of these died of cerebral hemorrhage  and disseminated intravascular coagulation (DIC) within 72 hours of starting induction therapy, one older patient died of severe pulmonary infection. The early death rate was 5.5% (4/73). All 69 cases that obtained CR remained in good clinical remission after a follow-up of 35-74 months  (median: 52 months).The drug toxicity profile with the use of As(2)O(3) showed mainly hepatotoxicity. Liver dysfunction was slight in most cases. There were no severe side effects in long term follow-up.
  
  
  CONCLUSIONS
  We conclude that APL patients may  benefit from the use of the combination of ATRA and As(2)O(3) in either remission induction or consolidation/maintenance.
authors.affiliation: Department of Hematology, Yinzhou People's Hospital, 251 Baizhang Road, Ningbo, Zhejiang Province, China.
authors.forename: Renzhi
authors.initials: R
authors.lastname: Pei
authors.forename: Junjie
authors.initials: J
authors.lastname: Cao
authors.forename: Junxia
authors.initials: J
authors.lastname: Ma
authors.forename: Pisheng
authors.initials: P
authors.lastname: Zhang
authors.forename: Xuhui
authors.initials: X
authors.lastname: Liu
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Du
authors.forename: Dong
authors.initials: D
authors.lastname: Chen
authors.forename: Keya
authors.initials: K
authors.lastname: Sha
authors.forename: Lieguang
authors.initials: L
authors.lastname: Chen
authors.forename: Shuangyue
authors.initials: S
authors.lastname: Li
authors.forename: Jingyi
authors.initials: J
authors.lastname: Wu
authors.forename: Zhen
authors.initials: Z
authors.lastname: Fan
authors.forename: Li
authors.initials: L
authors.lastname: Lin
authors.forename: Peipei
authors.initials: P
authors.lastname: Ye
authors.forename: Shanhao
authors.initials: S
authors.lastname: Tang
authors.forename: Bibo
authors.initials: B
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000008:administration & dosage; D060830:Consolidation Chemotherapy; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D010087:Oxides / Q000008:administration & dosage; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D001152:Arsenicals; D015514:Oncogene Proteins, Fusion; D010087:Oxides; C093476:promyelocytic leukemia-retinoic acid receptor alpha fusion oncoprotein; D014212:Tretinoin; D000077237:Arsenic Trioxide