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Management of acute promyelocytic leukemia: updated recommendations from an expert panel of the European LeukemiaNet

Miguel A. Sanz, Pierre Fenaux, Martin S. Tallman, Elihu H. Estey, Bob Löwenberg, Tomoki Naoe, Eva Lengfelder, Hartmut Döhner, Alan K. Burnett, Sai-Juan Chen, Vikram Mathews, Harry Iland, Eduardo Rego, Hagop Kantajian, Lionel Adès, Giuseppe Avvisati, Pau Montesinos, Uwe Platzbecker, Farhad Ravandi, Nigel H. Russell and Francesco Lo-Coco

Abstract

Since the comprehensive recommendations for the management of APL reported in 2009, several studies have provided important insights, particularly regarding the role of ATO in frontline therapy. Ten years later, a European LeukemiaNet expert panel has reviewed the recent advances in the management of APL in both frontline and relapse settings in order to develop updated evidence- and expert opinion-based recommendations on the management of this disease. Together with providing current indications on genetic diagnosis, modern risk-adapted frontline therapy and salvage treatment, the review contains specific recommendations for the identification and management of the most important complications such as the bleeding disorder, APL differentiation syndrome, QT prolongation and other ATRA- and ATO-related toxicities, as well as for molecular assessment of the response to treatment. Finally, the approach to special situations is also discussed, including management of APL in children, elderly patients, and pregnant women. The most important challenges remaining in APL include early death, which still occurs before and during induction therapy, and optimizing treatment in patients with high-risk disease.

  • Submitted January 10, 2019.
  • Accepted February 20, 2019.