Original Manuscript
Leukemia (2003) 17, 339–342. doi:10.1038/sj.leu.2402807
Early onset of chemotherapy can reduce the incidence of ATRA syndrome in newly diagnosed acute promyelocytic leukemia (APL) with low white blood cell counts: results from APL 93 trial
S de Botton, S Chevret, V Coiteux, H Dombret, M Sanz, J San Miguel, D Caillot, A Vekhoff, M Gardembas, A Stamatoulas, E Conde, A Guerci, C Gardin, M Fey, D Cony Makhoul, O Reman, J de la Serna, F Lefrere, C Chomienne, L Degos and P Fenaux for the European APL group
Correspondence: P Fenaux, Service d'Hématologie Clinique, Hôpital Avicenne, 125 route de Stalingrad, 93009 Bobigny, France; Fax: 33 (0)1 48 95 54 50/99
Received 27 May 2002; Accepted 30 August 2002.
Abstract
Treatment combining ATRA and chemotherapy (CT) has improved the outcome of APL patients, by comparison with CT alone. ATRA syndrome is a life-threatening complication of ATRA treatment whose prophylaxis remains somewhat controversial. In APL93 trial, newly diagnosed APL patients 
65 years and with initial WBC counts below 5000/mm3 were randomized between ATRA until CR achievement followed by CT (ATRA 
CT) and ATRA with early addition of CT, on day 3 of ATRA treatment (ATRA + CT). The incidence of ATRA syndrome in the ATRA CT arm was 18% (22/122) as compared to 9.2% (17/184) in the ATRA + CT arm (P = 0.035). In the ATRA CT arm, three (2.5%) patients died from ATRA syndrome, as compared to one (0.5%) in the ATRA + CT group. Early addition of chemotherapy to ATRA in newly diagnosed APL with low WBC counts significantly reduced the incidence of ATRA syndrome.
Keywords:
acute promyelocytic leukemia, ATRA syndrome, prophylaxis chemotherapy