Tricks of the trade for the appropriate management of newly diagnosed acute promyelocytic leukemia

Abstract

Most reviews on the state-of-the-art treatment in acute promyelocytic leukemia (APL) have focused mainly on the comparison of therapeutic approaches, including all-trans retinoic acid (ATRA) and chemotherapy. However, outcome of individual patients also depends on appropriate knowledge of several aspects related to APL management that are less appreciated and/or are underestimated in the literature. These aspects include appropriate diagnostic strategy, use of supportive care, early recognition and treatment of life-threatening complications typically associated with APL and its specific treatment, tools and timing for adequate evaluation of response, and, finally, management of the disease in special conditions such as older patients and pregnant women. Besides reviewing current consensus and controversies on the use of ATRA and chemotherapy in the distinct treatment phases (eg, induction, consolidation, maintenance), this article addresses the aforementioned issues on APL management ("tricks of the trade") with special emphasis on several peculiar aspects that distinguish APL from other acute myeloid leukemias. © 2005 by The American Society of Hematology.