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Retinoic acid syndrome: a problem of the past?

Leukemia volume 16, pages 160–161 (2002)Cite this article

All-trans retinoic acid (ATRA) has been the major advance that has made acute promyelocytic leukemia (APL) the most curable form of adult acute myeloid leukemia (AML). In large cooperative group trials, the 4–5-year disease-free survival rate using ATRA in patients with APL is now 70 to 80%.1,2,3,4 These outstanding results have prompted investigators to address four major questions regarding the use of retinoids in this subgroup of leukemia. The first is: in whom do we prevent relapse with maintenance therapy? The second is: can exposure to chemotherapy be minimized? The third is: what are the important prognostic factors to tailor our therapy even better? And the fourth is: what is the best way to minimize toxicity associated with ATRA, specifically retinoid acid syndrome.

The PETHEMA Spanish cooperative group has addressed two of these areas and focused on administering maintenance chemotherapy to all patients and minimizing chemotherapy. In their trial, cytarabine is omitted both during induction and in consolidation, and maintenance ATRA, 6-MP, and methotrexate are administered to all patients. With that strategy, the 4-year disease-free survival rate of 167 patients who achieved complete remission out of 186 patients on the trial is 90%. The event-free survival for all 186 patients entered is 79%.5 The PETHEMA group, along with the GIMEMA group, have looked at a combined cohort of patients treated with this approach and have identified prognostic factors.3 White blood cell count at presentation and platelet count were important prognostic factors with which one could segregate patients into low risk, high risk, and intermediate risk. Low-risk patients had white counts less than 10000 × 106/l and a platelet count above 40000 × 106/l; high-risk patients had white blood cell counts above 10000 × 106/l; and intermediate-risk patients had white blood cell counts less than 10000 × 106/l and low platelet counts.

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  1. Division of Hematology-Oncology, Northwestern University Medical School, and the Robert H Lurie Comprehensive Cancer Center, Chicago, IL, USA

    MS Tallman

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This paper is part of a series of keynote addresses to be published in Leukemia. They were presented at the Acute Leukemia Forum, San Francisco, 20 April 2001. Supported by an unrestricted educational grant from Immunex.

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Tallman, M. Retinoic acid syndrome: a problem of the past?. Leukemia 16, 160–161 (2002). https://doi.org/10.1038/sj.leu.2402344

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