Differentiation therapy for acute promyelocytic leukemia with all-trans retinoic acid: 10-year experience of its clinical application

PURPOSE: To summarize the experiences in using all-trans retinoic acid (ATRA) for the differentiation therapy for acute promyelocytic leukemia (APL) since our introduction of its use in clinic in 1986. DATA RESOURCES: Data resources came from Chinese Journal of Hematology, English-language literature using MEDLINE (1988-1998), book entitled "Treatment of Malignancies by Inducing Differentiation and Apoptosis" published by Shanghai Publishing House on Sciences and Technology, and our recent data to be published. STUDY SELECTION: Thirty-five articles related to the purpose of this review were reviewed. DATA EXTRACTION: Data were checked for their quality, reliance and originality. RESULTS: ATRA combined with chemotherapy can decrease the incidence of retinoic acid syndrome and produce a very high remission rate (90%-95%). Post-remission treatment should include chemotherapy and ATRA, the 5-year survival probability was able to attain 0.71 +/- 0.06. The main problem in the treatment is early tolerance to ATRA and relapse of the disease. The most effective treatments for relapsed APL is to use arsenic trioxide. CONCLUSION: The combination of ATRA, chemotherapy and arsenic oxide in the treatment of APL for elevating the remission rate and prolonging survival time deserves further study.