Management of Acute Promyelocytic Leukemia at Extremes of Age

Simple Summary This review summarizes various unique aspects of managing APL in very elderly and pediatric patients, particularly treatment with ATO, toxicities, and dose modifications. Tailored treatment with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) has revolutionized the outcome of acute promyelocytic leukemia (APL) from a uniformly fatal disease to one of the most curable malignant diseases in humans. Due to its high efficacy, ATO/ATRA is the standard first-line therapy in younger adult, non-high-risk APL patients. However, early death is still a major issue in APL, particularly in older patients. Thus, rapid diagnostics, immediate access to ATRA-based therapy, and supportive care are of utmost importance. Nevertheless, challenging situations occur, particularly in patients excluded from controlled studies with clinical knowledge mainly based on case reports and registries. Besides the treatment of newly diagnosed patients, managing toxicities and complications remains challenging. This review discusses the approach to the treatment of APL in elderly and pediatric patients.

Automated summary

This review summarizes the unique aspects of managing acute promyelocytic leukemia (APL) in very elderly and pediatric patients, focusing on treatment with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO), toxicities, and dose modifications. ATO/ATRA is the standard therapy for younger adult, non-high-risk APL patients, but early death remains a challenge, especially in older patients. Rapid diagnostics, immediate access to ATRA-based therapy, and supportive care are crucial. This review also discusses the management of toxicities and complications in APL patients.