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All-trans retinoic acid (ATRA) combined with idarubicin with or without cytarabine provides a >90% overall response rate (ORR) and >80% cures in low- and intermediate-risk acute promyelocytic leukemia (APML). Given the very high ORR to arsenic trioxide (ATO) in relapsed APML, investigators conducted a prospective, randomized, noninferiority, phase III trial, in which 158 patients with newly diagnosed APML received either ATRA-ATO induction plus 4 cycles of consolidation or standard ATRA plus idarubicin induction followed by 3 cycles of consolidation and 2 years of maintenance chemotherapy.
At median follow-up of 34.4 months, all 77 ATRA-ATO recipients and 75 of 79 ATRA-chemotherapy recipients (95%) achieved complete remission with induction.…