A Potential New Standard of Care for High-Risk Acute Promyelocytic Leukemia

Chemotherapy-free induction therapy with all-trans retinoic acid (ATRA) plus arsenic trioxide (ATO) is the standard of care for standard-risk acute promyelocytic leukemia (APML; white blood cell [WBC] count, ≤10×10⁹/L at diagnosis), conferring higher cure rates and lower risk for early mortality from disease-related coagulopathy. High-risk patients have WBC count >10×10⁹/L and greater likelihood of relapse and early mortality despite more-intensive chemotherapy plus ATRA. In a phase 3 industry-supported trial, Platzbecker et al. assessed induction with ATRA–ATO and 2 doses of idarubicin in the first cycle followed by consolidation with 4 cycles of ATRA–ATO, versus induction with ATRA plus 4 doses of idarubicin followed by 3 cycles of…