Retrospective study of arsenic trioxide for childhood acute promyelocytic leukemia in China: a single-center experience

There are very limited reports about childhood acute promyelocytic leukemia (APL), especially about arsenic trioxide (ATO) treatment in both induction and post-remission regimens. 35 newly diagnosed APL patients received ATO treatment in our center and the clinical course as well as the outcome of them was investigated. The dose of intravenous ATO was 0.15-0.17 mg/kg per day, only one patient got 0.33 mg/kg per day, maximum dose was 10 mg per day in induction therapy with minimal chemotherapy treatment (CT) for hyperleukocytosis. Anthracycline or anthracycline-based CT was used for consolidation therapy and followed by 0.10-0.15 mg/kg per day ATO treatment in maintenance therapy. The continuous detection for morphology of bone marrow and PML-RARa were necessary for administrating CT or not. 3 patients died during induction therapy for intracranial hemorrhage, leukocytosis and septic shock. Total of 30 patients achieved complete remission (CR) and were followed-up for 10-108 months. The overall survival (OS) for all patients was 82.7%, whereas the OS for patients obtained CR was 95.8%. The event-free survival for 5 years was 80.3%. Disseminated intravascular coagulation could be under control to reduce induction mortality with adequate supportive care, especially in the first 2 weeks. The side effects of ATO were mild and transient. This regimen of ATO treatment both in induction and post-remission therapy was effective and safe for childhood APL to get long-term survival.