title: All-Trans Retinoic Acid plus Arsenic Trioxide versus All-Trans Retinoic Acid plus Chemotherapy for Newly Diagnosed Acute Promyelocytic Leukemia: A Meta-Analysis.
abstract: BACKGROUND
  Recently, the all-trans retinoic acid (ATRA) plus arsenic trioxide (ATO) protocol has become a promising first-line therapeutic approach in patients with newly diagnosed acute promyelocytic leukemia (APL), but its benefits compared with standard ATRA plus chemotherapy regimen needs to be proven. Herein, we conducted a meta-analysis comparing the efficacy of ATRA plus ATO with ATRA plus chemotherapy for adult patients with newly diagnosed APL.
  
  
  METHODS
  We systematically searched biomedical electronic databases and conference proceedings through February 2016. Two reviewers independently assessed all studies for relevance and validity.
  
  
  RESULTS
  Overall, three studies were eligible for inclusion in this meta-analysis, which included a total of 585 patients, with 317 in ATRA plus ATO group and 268 in ATRA plus chemotherapy group. Compared with patients who received ATRA and chemotherapy, patients who received ATRA plus ATO had a significantly better event-free survival (hazard ratio [HR] = 0.38, 95% confidence interval [CI]: 0.22-0.67, p = 0.009), overall survival (HR = 0.44, 95% CI: 0.24-0.82, p = 0.009), complete remission rate (relative risk [RR] = 1.05; 95% CI: 1.01-1.10; p = 0.03). There were no significant differences in early mortality (RR = 0.48; 95% CI: 0.22-1.05; p = 0.07).
  
  
  CONCLUSIONS
  Thus, this analysis indicated that ATRA plus ATO protocol may be preferred to standard ATRA plus chemotherapy protocol, particularly in low-to-intermediate risk APL patients. Further larger trials were needed to provide more evidence in high-risk APL patients.
authors.affiliation: Institute of Hematology, Department of Hematology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
authors.forename: Yafang
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Institute of Hematology, Department of Hematology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Liu
authors.affiliation: Institute of Hematology, Department of Hematology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.|Key Laboratory of Hematopoietic Malignancies Zhejiang Province, Hangzhou, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Jin
authors.affiliation: Institute of Hematology, Department of Hematology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.|Key Laboratory of Hematopoietic Malignancies Zhejiang Province, Hangzhou, China.
authors.forename: Yinjun
authors.initials: Y
authors.lastname: Lou
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000627:therapeutic use*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D010087:Oxides / Q000627:therapeutic use*; D016896:Treatment Outcome; D014212:Tretinoin / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D014212:Tretinoin; D000077237:Arsenic Trioxide