Current and emerging treatments for acute promyelocytic leukemia

Introduction: The introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) to clinical practice revolutionized the APL therapy and allowed development of chemotherapy-free regimen with high success rates in low- and intermediate-risk patients. Although APL is now a curable disease, the early deaths are common, up to 30% in some studies.Areas covered: Factors associated with high induction deaths such as delays in starting ATRA therapy, differentiation syndrome, unrecognized fluid overload, and coagulopathy were discussed. We searched the PubMed for relevant articles from inception to 2019. We summarized current and emerging treatment options for patients with low and high-risk APL and highlighted relevant clinical points that need to be monitored closely during induction therapy.Expert opinion: Although patients universally respond to ATRA + ATO based therapy, induction death still remains as one of the main obstacles of APL therapy. Efforts in this area must focus to facilitate prompt diagnosis, earlier initiation of therapy, and vigorous clinical monitoring to prevent expected complications of APL and its therapy. Oral arsenic compounds that have been shown to be equally effective may substitute IV formulation, in combination with ATRA, thus allowing a complete oral management of APL.