It has been reported that arsenic trioxide (ATO) can induce remissions in 95% of relapsed patients, but few studies have addressed the integration of ATO into the primary management of acute promyelocytic leukaemia (APL).

This study evaluated the efficacy of a single cycle of ATO-based consolidation therapy in a treatment regimen designed to decrease exposure to other cytotoxic agents. After induction with all-trans-retinoic acid (ATRA) and daunorubicin (DRN), untreated patients with APL received 3 days of cytarabine and DRN followed by 30 doses of ATO beginning on day 8. Molecular remitters received 2 years of risk-based maintenance therapy.

45 patients with confirmed APL received induction therapy on protocol. Of these, 41 achieved remission and four patients died (one before treatment was initiated). Thirty-seven patients received consolidation and maintenance; of these one patient relapsed (CNS) and one died in remission during maintenance therapy (hepatic sickle cell crisis). With a median follow-up of 2.7 years, estimated disease-free survival was 90%; overall survival for all patients was 88%. Despite a total anthracycline dose of only 360 mg/m2, cardiac ejection fraction decreased by 20% in 20% of patients.

The authors concluded that their data in addition to other recent studies using ATO in the primary management of APL, support the important role that ATO can play in the primary management of this curable disease.