All-trans retinoic acid:: Treatment and toxicity in acute promyelocytic leukemia

The introduction of all-trans retinoic acid (ATRA) has further changed the manage-ment of acute promyelocytic leukemia (APL). After using of ATRA, the rate of early death and relapse has decreased dramatically. From February 1997 to March 2000, 12 consecutive patients with APL were treated with ATRA at an oral dose of 45mg/m(2)/d alone or in combination with chemotherapy. In 11 cases treated with ATRA alone, 11 (100%) achieved complete remission (CR) between 35-68 days. The other patient treated with ATRA+Daunorubicin died from central nervous system hemorrhage on the fourth day of treatment. The side effects were relatively mild as compared with chemotherapy. Retinoic acid syndrome was seen in two patients and successfully treated with dexamethasone. Among 11 patients closely followed after CR, 1 died at first relapse. In conclusion; ATRA has been able to induce a very high CR rate in newly diagnosed APL and has less toxic and tolerable side effects.