Review
How I treat children and adolescents with acute promyelocytic leukaemia
Oussama Abla,
Raul C. Ribeiro,
Corresponding Author
Oussama Abla
Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Correspondence: Oussama Abla, MD, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
E-mail: [email protected]
Search for more papers by this authorRaul C. Ribeiro
Department of Oncology and International Outreach Program, Saint Jude Children's Research Hospital, Memphis, TN, USA
Search for more papers by this authorOussama Abla,
Raul C. Ribeiro,
Corresponding Author
Oussama Abla
Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
Correspondence: Oussama Abla, MD, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
E-mail: [email protected]
Search for more papers by this authorRaul C. Ribeiro
Department of Oncology and International Outreach Program, Saint Jude Children's Research Hospital, Memphis, TN, USA
Search for more papers by this authorSummary
Acute promyelocytic leukaemia (APL) is a rare subtype of acute myeloid leukaemia. The outcome of paediatric APL has improved substantially over the past 20 years; cure rates above 80% are expected when all-trans retinoic acid (ATRA) is given with anthracycline-based regimens. The presenting features of paediatric APL may include severe bleeding and thrombotic complications, which contribute to the high early death rate. The incidence of leucocytosis and the microgranular subtype is greater in paediatric than adult APL, and children experience greater ATRA-related toxicity. It is crucial to begin ATRA therapy and intensive platelet and fibrinogen replacement on first suspicion of APL. Recent risk-adapted therapeutic trials have shown that patients at greater risk of relapse benefit from the introduction of high-dose cytarabine during consolidation. Combination therapy with ATRA and arsenic trioxide provides very effective frontline treatment and may reduce the need for subsequent anthracycline therapy.
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