In the ATRA plus arsenic trioxide group, grade 3 to 4 alopecia occurred in 5% and 3% of patients after course 1 and 2 of treatment, respectively, compared with 23% and 28% of patients in the ATRA plus idarubicin group, respectively.1

Researchers found that patients in the ATRA plus arsenic trioxide group required significantly less supportive care than those in the ATRA plus idarubicin group.

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“ATRA and arsenic trioxide is a feasible treatment in low-risk and high-risk patients with acute promyelocytic leukaemia, with a high cure rate and less relapse than, and survival not different to, ATRA and idarubicin, with a low incidence of liver toxicity. However, no improvement in quality of life was seen,” the authors concluded.1

Current National Comprehensive Cancer Network (NCCN) guidelines for the treatment of APL recommend initial treatment induction for low- or intermediate-risk patients with ATRA plus arsenic trioxide (category 1), ATRA plus idarubicin alone (category 1), ATRA plus daunorubicin and cytarabine (category 1 for certain patients), or enrollment in a clinical trial. 3

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For high-risk patients, the NCCN recommends ATRA plus cytarabine and daunorubicin, ATRA plus idarubicin alone, ATRA plus idarubicin and arsenic trioxide, or enrollment in a clinical trial. ATRA plus arsenic trioxide is also recommended in high-risk patients unable to tolerate anthracyclines.

Because ATRA plus arsenic trioxide is already recommended for patients with low-risk disease and for those with high-risk disease who are unable to tolerate anthracyclines, the findings of the study may only influence treatment decisions for high-risk patients with APL.

Of note, the doses used in this study are not the recommended doses for ATRA plus arsenic trioxide regimens included in the NCCN guidelines.


  1. Burnett AK, Russell N, Hills RK, et al. Arsenic trioxide and all-trans retinoic acid treatment for acute promyelocytic leukaemia in all risk groups (AML17): results of a randomised, controlled, phase 3 trial. [published online ahead of print September 14, 2015]. Lancet Oncol. doi: 10.1016/S1470-2045(15)00193-X.
  2. Ravandi F, Estey EH, Appelbaum FR, et al. Gemtuzumab ozogamicin: time to resurrect? J Clin Oncol. 2012;30(32):3921-3923.
  3. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Acute Myeloid Leukemia. V 1.2015. Updated December 3, 2014. Accessed September 21, 2015.