Induction Therapy

All of the trials given in Table 6.1 incorporated ATRA into induction therapy and, with few exceptions, reported CR rates are greater than or equal to 90%. What, then, is the best strategy for induction therapy of APL? While the choice of "best" induction therapy may differ for specific subsets of patients, for most patients the weight of evidence supports the use of ATRA, 45 mg/m2/day in divided doses until CR, plus anthracycline-based chemotherapy started on day 2 or 3 (to allow partial improvement of the coagulopathy by ATRA). The choice of anthracycline (daunorubicin vs idarubicin), and the dose, vary by center and group, but excellent results have been achieved using 12 mg/ m2 of idarubicin on days 2, 4, 6, and 8,35 as well as 60 mg/m2 of daunorubicin on days 3-5.20 This type of combined strategy minimizes the incidence of APL differentiation syndrome, results in disease control in virtually all patients and, in experienced hands, leads to CR rates of more than 95%. Satisfactory rates of CR can also be achieved using ATRA alone for induction, but long-term disease control may be inferior.21

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