The Simpler the Better: Oral Arsenic for Acute Promyelocytic Leukemia

Hong-Hu Zhu, Jiong Hu, Francesco Lo Coco and Jie Jin


Arsenic trioxide (ATO) and all-trans retinoic acid have become the front-line treatments for patients with acute promyelocytic leukemia (APL). Despite the long wait for an oral arsenic drug, a commercially available agent, "Realgar-Indigo naturalis formula (RIF)", was not launched in China until 2009. Since then, over 5000 patients with APL have been treated with oral RIF in China. Oral arsenic not only shows a clinical efficacy comparable to that of IV formulations but also displays a better safety profile, improved quality of life and lower medical costs for patients. The promising results promote incorporating an outpatient postremission therapy model into clinical practice for both low-risk and high-risk APL patients in China. In this review, we discuss the evolution of oral arsenic RIF in the treatment of APL, with a special focus on how to address the related complications during induction therapy.

  • Submitted March 24, 2019.
  • Revision received May 1, 2019.
  • Accepted April 29, 2019.