Acute promyelocytic leukemia medical therapy

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Acute promyelocytic leukemia Microchapters


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shyam Patel [2], Sogand Goudarzi, MD [3]; Grammar Reviewer: Natalie Harpenau, B.S.[4]


The treatment of acute promyelocytic leukemia is broadly divided into anti-leukemia therapies and supportive therapies. Anti-leukemia therapies function to eliminate cancer cells, whereas supportive therapies are temporizing measures that can control the disease for a short time until anti-leukemic therapy takes effect. Anti-leukemic therapies include all-trans retinoic acid, arsenic trioxide, gemtuzumab ozogamicin, and cytarabine. Supportive therapies include transfusions (such as cryoprecipitate or platelet transfusions) and granulocyte colony stimulating factor.

Medical Therapy

Anti-leukemic Therapies

Supportive Therapies

  • Cryoprecipitate transfusion:
  • Packed red blood cell transfusion:
  • Platelet transfusion:
    • Platelet transfusion is indicated when the platelet count decreases to less than 10,000 cells per microliter. This low platelet count occurs especially when a patient received induction chemotherapy, such as cytarabine or anthacycline.[30]
    • Adverse effects:
      • Risks include sepsis (since platelet units are stored at room temperature where there is a high risk for contamination), volume overload, and thrombosis (less likely).[31]
  • Granulocyte colony stimulating factor (G-CSF):
    • G-CSF is sometimes uses to help improve the neutrophil count in patients with acute promyelocytic leukemia. It is important to use G-CSF only when there is no active leukemia, as G-CSF can stimulate the proliferation of leukemic blasts.[32]
    • Patients who receive G-CSF are usually those who have had a favorable anti-tumor response to chemotherapy but have not recovered their normal blood counts. G-CSF helps enhance normal blood cell count recovery.[33]
    • Adverse effects:


  1. Abaza Y, Kantarjian H, Garcia-Manero G, Estey E, Borthakur G, Jabbour E; et al. (2017). "Long-term outcome of acute promyelocytic leukemia treated with all-trans-retinoic acid, arsenic trioxide, and gemtuzumab". Blood. 129 (10): 1275–1283. doi:10.1182/blood-2016-09-736686. PMC 5413297. PMID 28003274.
  2. Montesinos, Pau; Sanz, Miguel A (2011). "THE DIFFERENTIATION SYNDROME IN PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA: EXPERIENCE OF THE PETHEMA GROUP AND REVIEW OF THE LITERATURE". Mediterranean Journal of Hematology and Infectious Diseases. 3 (1): e2011059. doi:10.4084/mjhid.2011.059. ISSN 2035-3006.
  3. Montesinos, P.; Bergua, J. M.; Vellenga, E.; Rayon, C.; Parody, R.; de la Serna, J.; Leon, A.; Esteve, J.; Milone, G.; Deben, G.; Rivas, C.; Gonzalez, M.; Tormo, M.; Diaz-Mediavilla, J.; Gonzalez, J. D.; Negri, S.; Amutio, E.; Brunet, S.; Lowenberg, B.; Sanz, M. A. (2008). "Differentiation syndrome in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline chemotherapy: characteristics, outcome, and prognostic factors". Blood. 113 (4): 775–783. doi:10.1182/blood-2008-07-168617. ISSN 0006-4971.
  4. 4.0 4.1 Kumar S, Yedjou CG, Tchounwou PB (2014). "Arsenic trioxide induces oxidative stress, DNA damage, and mitochondrial pathway of apoptosis in human leukemia (HL-60) cells". J Exp Clin Cancer Res. 33: 42. doi:10.1186/1756-9966-33-42. PMC 4049373. PMID 24887205.
  5. Iland, Harry J.; Seymour, John F. (2013). "Role of Arsenic Trioxide in Acute Promyelocytic Leukemia". Current Treatment Options in Oncology. 14 (2): 170–184. doi:10.1007/s11864-012-0223-3. ISSN 1527-2729.
  6. McCulloch D, Brown C, Iland H (2017). "Retinoic acid and arsenic trioxide in the treatment of acute promyelocytic leukemia: current perspectives". Onco Targets Ther. 10: 1585–1601. doi:10.2147/OTT.S100513. PMC 5359123. PMID 28352191.
  7. Falchi L, Verstovsek S, Ravandi-Kashani F, Kantarjian HM (2016). "The evolution of arsenic in the treatment of acute promyelocytic leukemia and other myeloid neoplasms: Moving toward an effective oral, outpatient therapy". Cancer. 122 (8): 1160–8. doi:10.1002/cncr.29852. PMC 5042140. PMID 26716387.
  8. Jen, Emily Y.; Ko, Chia-Wen; Lee, Jee Eun; Del Valle, Pedro L.; Aydanian, Antonina; Jewell, Charles; Norsworthy, Kelly J.; Przepiorka, Donna; Nie, Lei; Liu, Jiang; Sheth, Christopher M.; Shapiro, Marjorie; Farrell, Ann T.; Pazdur, Richard (2018). "FDA Approval: Gemtuzumab Ozogamicin for the Treatment of Adults with Newly Diagnosed CD33-Positive Acute Myeloid Leukemia". Clinical Cancer Research. 24 (14): 3242–3246. doi:10.1158/1078-0432.CCR-17-3179. ISSN 1078-0432.
  9. Wei, Andrew H.; Tiong, Ing S. (2017). "Midostaurin, enasidenib, CPX-351, gemtuzumab ozogamicin, and venetoclax bring new hope to AML". Blood. 130 (23): 2469–2474. doi:10.1182/blood-2017-08-784066. ISSN 0006-4971.
  10. Planque, Robert; Jager, Eva; van der Velden, Vincent H. J.; te Marvelde, Jeroen G.; Walter, Roland B.; Agur, Zvia; Vainstein, Vladimir (2011). "Targeted Drug Delivery by Gemtuzumab Ozogamicin: Mechanism-Based Mathematical Model for Treatment Strategy Improvement and Therapy Individualization". PLoS ONE. 6 (9): e24265. doi:10.1371/journal.pone.0024265. ISSN 1932-6203.
  11. Lo Coco F, Ammatuna E, Noguera N (January 2006). "Treatment of acute promyelocytic leukemia with gemtuzumab ozogamicin". Clin Adv Hematol Oncol. 4 (1): 57–62, 76–7. PMID 16562371.
  12. Baron, Jeffrey; Wang, Eunice S. (2018). "Gemtuzumab ozogamicin for the treatment of acute myeloid leukemia". Expert Review of Clinical Pharmacology. 11 (6): 549–559. doi:10.1080/17512433.2018.1478725. ISSN 1751-2433.
  13. 13.0 13.1 Ravandi, Farhad; Estey, Eli; Jones, Dan; Faderl, Stefan; O'Brien, Susan; Fiorentino, Jackie; Pierce, Sherry; Blamble, Deborah; Estrov, Zeev; Wierda, William; Ferrajoli, Alessandra; Verstovsek, Srdan; Garcia-Manero, Guillermo; Cortes, Jorge; Kantarjian, Hagop (2009). "Effective Treatment of Acute Promyelocytic Leukemia With All-Trans-Retinoic Acid, Arsenic Trioxide, and Gemtuzumab Ozogamicin". Journal of Clinical Oncology. 27 (4): 504–510. doi:10.1200/JCO.2008.18.6130. ISSN 0732-183X.
  14. 14.0 14.1 Zhang, Li; Zou, Yao; Chen, Yumei; Guo, Ye; Yang, Wenyu; Chen, Xiaojuan; Wang, Shuchun; Liu, Xiaoming; Ruan, Min; Zhang, Jiayuan; Liu, Tianfeng; Liu, Fang; Qi, Benquan; An, Wenbin; Ren, Yuanyuan; Chang, Lixian; Zhu, Xiaofan (2018). "Role of cytarabine in paediatric acute promyelocytic leukemia treated with the combination of all-trans retinoic acid and arsenic trioxide: a randomized controlled trial". BMC Cancer. 18 (1). doi:10.1186/s12885-018-4280-2. ISSN 1471-2407.
  15. Lo-Coco, F.; Avvisati, G.; Vignetti, M.; Breccia, M.; Gallo, E.; Rambaldi, A.; Paoloni, F.; Fioritoni, G.; Ferrara, F.; Specchia, G.; Cimino, G.; Diverio, D.; Borlenghi, E.; Martinelli, G.; Di Raimondo, F.; Di Bona, E.; Fazi, P.; Peta, A.; Bosi, A.; Carella, A. M.; Fabbiano, F.; Pogliani, E. M.; Petti, M. C.; Amadori, S.; Mandelli, F. (2010). "Front-line treatment of acute promyelocytic leukemia with AIDA induction followed by risk-adapted consolidation for adults younger than 61 years: results of the AIDA-2000 trial of the GIMEMA Group". Blood. 116 (17): 3171–3179. doi:10.1182/blood-2010-03-276196. ISSN 0006-4971.
  16. Ortega, Juan J.; Madero, Luis; Martín, Guillermo; Verdeguer, Amparo; García, Purificación; Parody, Ricardo; Fuster, José; Molines, Antonio; Novo, Andrés; Debén, Guillermo; Rodríguez, Antonia; Conde, Eulogio; de la Serna, Javier; Allegue, María J.; Capote, Francisco J.; González, José D.; Bolufer, Pascual; González, Marcos; Sanz, Miguel A. (2005). "Treatment With All-TransRetinoic Acid and Anthracycline Monochemotherapy for Children With Acute Promyelocytic Leukemia: A Multicenter Study by the PETHEMA Group". Journal of Clinical Oncology. 23 (30): 7632–7640. doi:10.1200/JCO.2005.01.3359. ISSN 0732-183X.
  17. Prakasha Gowda, A. S.; Polizzi, Joanna M.; Eckert, Kristin A.; Spratt, Thomas E. (2010). "Incorporation of Gemcitabine and Cytarabine into DNA by DNA Polymerase β and Ligase III/XRCC1". Biochemistry. 49 (23): 4833–4840. doi:10.1021/bi100200c. ISSN 0006-2960.
  18. Löwenberg, Bob; Pabst, Thomas; Vellenga, Edo; van Putten, Wim; Schouten, Harry C.; Graux, Carlos; Ferrant, Augustin; Sonneveld, Pieter; Biemond, Bart J.; Gratwohl, Alois; de Greef, Georgine E.; Verdonck, Leo F.; Schaafsma, Martijn R.; Gregor, Michael; Theobald, Matthias; Schanz, Urs; Maertens, Johan; Ossenkoppele, Gert J. (2011). "Cytarabine Dose for Acute Myeloid Leukemia". New England Journal of Medicine. 364 (11): 1027–1036. doi:10.1056/NEJMoa1010222. ISSN 0028-4793.
  19. Shepshelovich, Daniel; Edel, Yonatan; Goldvaser, Hadar; Dujovny, Tal; Wolach, Ofir; Raanani, Pia (2015). "Pharmacodynamics of cytarabine induced leucopenia: a retrospective cohort study". British Journal of Clinical Pharmacology. 79 (4): 685–691. doi:10.1111/bcp.12530. ISSN 0306-5251.
  20. McGowan, John V; Chung, Robin; Maulik, Angshuman; Piotrowska, Izabela; Walker, J Malcolm; Yellon, Derek M (2017). "Anthracycline Chemotherapy and Cardiotoxicity". Cardiovascular Drugs and Therapy. 31 (1): 63–75. doi:10.1007/s10557-016-6711-0. ISSN 0920-3206.
  21. Sun, Zimin; Zhou, Li; Liu, Xin; Liu, Huilan; Zhu, Weibo; Cai, Xiaoyan; Song, Kaidi; Zheng, Changcheng; Tang, Baolin (2016). "A comparative study of idarubicin 12 mg/m2 and 8 mg/m2 combined with cytarabine as the first induction regimen for adult acute myeloid leukemia patients". OncoTargets and Therapy: 985. doi:10.2147/OTT.S96176. ISSN 1178-6930.
  22. Volkova, Maria; Russell, Raymond (2012). "Anthracycline Cardiotoxicity: Prevalence, Pathogenesis and Treatment". Current Cardiology Reviews. 7 (4): 214–220. doi:10.2174/157340311799960645. ISSN 1573-403X.
  23. Herrmann, Joerg; Lerman, Amir; Sandhu, Nicole P.; Villarraga, Hector R.; Mulvagh, Sharon L.; Kohli, Manish (2014). "Evaluation and Management of Patients With Heart Disease and Cancer: Cardio-Oncology". Mayo Clinic Proceedings. 89 (9): 1287–1306. doi:10.1016/j.mayocp.2014.05.013. ISSN 0025-6196.
  24. Fathi AT, Karp JE (September 2009). "New agents in acute myeloid leukemia: beyond cytarabine and anthracyclines". Curr Oncol Rep. 11 (5): 346–52. PMC 3066101. PMID 19679009.
  25. Nascimento B, Goodnough LT, Levy JH (December 2014). "Cryoprecipitate therapy". Br J Anaesth. 113 (6): 922–34. doi:10.1093/bja/aeu158. PMC 4627369. PMID 24972790.
  26. Pandey S, Vyas GN (May 2012). "Adverse effects of plasma transfusion". Transfusion. 52 Suppl 1: 65S–79S. doi:10.1111/j.1537-2995.2012.03663.x. PMC 3356109. PMID 22578374.
  27. Ikezoe, Takayuki (2013). "Pathogenesis of disseminated intravascular coagulation in patients with acute promyelocytic leukemia, and its treatment using recombinant human soluble thrombomodulin". International Journal of Hematology. 100 (1): 27–37. doi:10.1007/s12185-013-1463-0. ISSN 0925-5710.
  28. Sahu S, Hemlata, Verma A (September 2014). "Adverse events related to blood transfusion". Indian J Anaesth. 58 (5): 543–51. doi:10.4103/0019-5049.144650. PMC 4260299. PMID 25535415.
  29. Brittenham GM (January 2011). "Iron-chelating therapy for transfusional iron overload". N. Engl. J. Med. 364 (2): 146–56. doi:10.1056/NEJMct1004810. PMC 3078566. PMID 21226580.
  30. Song YH, Peng P, Qiao C, Zhang R, Li JY, Lu H (2017). "Low platelet count is potentially the most important contributor to severe bleeding in patients newly diagnosed with acute promyelocytic leukemia". Onco Targets Ther. 10: 4917–4924. doi:10.2147/OTT.S144438. PMC 5640392. PMID 29062237.
  31. Pandey S, Vyas GN (May 2012). "Adverse effects of plasma transfusion". Transfusion. 52 Suppl 1: 65S–79S. doi:10.1111/j.1537-2995.2012.03663.x. PMC 3356109. PMID 22578374.
  32. Usuki K, Nishizawa Y, Endo M, Osawa M, Kitazume K, Iki S, Watanabe M, Urabe A (October 1996). "Administration of granulocyte colony-stimulating factor during remission induction therapy with all-trans retinoic acid for acute promyelocytic leukemia". Int. J. Hematol. 64 (3–4): 213–9. PMID 8923783.
  33. Metcalf D (June 2010). "The colony-stimulating factors and cancer". Nat. Rev. Cancer. 10 (6): 425–34. doi:10.1038/nrc2843. PMC 3345291. PMID 20495576.
  34. McCullough J, Clay M, Herr G, Smith J, Stroncek D (October 1999). "Effects of granulocyte-colony-stimulating factor on potential normal granulocyte donors". Transfusion. 39 (10): 1136–40. PMID 10532609.

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