Choice of chemotherapy in induction, consolidation and maintenance in acute promyelocytic leukaemia

Miguel A. Sanz, Guillermo Martin, Francesco Lo Coco

Research output: Contribution to journalArticlepeer-review


Cure of acute promyelocytic leukaemia (APL) is now a reality for most patients through the use of combined all-trans retinoic acid (ATRA) and chemotherapy. The simultaneous administration of ATRA and anthracycline-based chemotherapy is currently considered the most appropriate induction therapy. However, no consensus has been reached on the consolidation strategy. Therapeutic efficacy apparently did not differ according to the number of cycles and types of drug combined with anthracyclines. Encouraging results have been reported recently using less-intensive chemotherapy with anthracyclines alone, leading to a significant reduction in treatment-related toxicity during the consolidation phase and a high degree of compliance. Some ongoing risk-adapted protocols are now exploring the potential synergistic effect of ATRA and chemotherapy given simultaneously in consolidation. Preliminary data suggest that higher molecular remission rates post-consolidation and improved outcome may be obtained through this strategy. Persistence or recurrence of molecular disease at the end of consolidation is strongly associated with impending relapse and poor prognosis, indicating the need for further aggressive therapy. As for maintenance therapy, once demonstrated, the advantage of using ATRA with or without low-dose methotrexate and 6-mercaptopurine has encouraged most groups to incorporate such treatment into their protocols for APL.

Original languageEnglish
Pages (from-to)433-451
Number of pages19
JournalBest Practice and Research: Clinical Haematology
Issue number3
Publication statusPublished - 2003


  • Acute promyelocytic leukaemia
  • All-trans retinoic acid
  • Anthracyclines

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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