A Canadian consensus on the management of newly diagnosed and relapsed acute promyelocytic leukemia in adults

The use of all-trans-retinoic acid (atra) and anthracyclines (with or without cytarabine) in the treatment of acute promyelocytic leukemia (APL) has dramatically changed the management and outcome of the disease over the past few decades. The addition of arsenic trioxide (ATO) in the relapsed setting-and, more recently, in reduced-chemotherapy or chemotherapy-free approaches in the first-line setting-continues to improve treatment outcomes by reducing some of the toxicities associated with anthracycline-based approaches. Despite those successes, a high rate of early death from complications of coagulopathy remains the primary cause of treatment failure before treatment begins. In addition to that pressing issue, clarity is needed about the use of ATO in the first-line setting and the role of hematopoietic stem-cell transplantation (HSCT) in the relapsed setting. The aim for the present consensus was to provide guidance to health care professionals about strategies to reduce the early death rate, information on the indications for HSCT and on the use of ATO in induction and consolidation in low-to-intermediate-risk and high-risk APL patients.