The role of adjuvant chemotherapy in the management of acute promyelocytic leukemia differentiation syndrome

Dominic LaBella, Samuel Regan, Heiko Konig, Daniel N. Egan, Neil A. Bailey, Raya Mawad, Morgan Gilbert, John M. Pagel, Jeffrey J. Pu

Research output: Contribution to journalArticlepeer-review


Acute Promyelocytic Leukemia (APL) is characterized by the t(15;17) chromosomal translocation resulting in a PML-RARA fusion protein. The all-trans-retinoic acid (ATRA) and Arsenic Trioxide (ATO) only regimens have demonstrated success in treating low- and intermediate-risk patients. However, induction with ATRA/ATO only regimens have been showing increased incidence of differentiation syndrome (DS), a potentially lethal complication, traditionally treated with dexamethasone. We conducted a three-institution retrospective study, aiming to evaluate the role of short-term adjuvant chemotherapy in managing moderate DS for patients with low- or intermediate-risk APL initially treated with ATRA/ATO only protocols. We evaluated the difference in incidence and duration of moderate DS in APL patients who were treated with ATRA/ATO with or without adjuvant chemotherapy. 57 low- or intermediate-risk APL patients were retrospectively identified and included for this study; 36 patients received ATRA/ATO only induction treatment, and 21 patients received ATRA/ATO/adjuvant chemotherapy combination induction therapy. Similar proportions of patients experienced DS in both groups (66.7% vs. 81.0%, P = 0.246). The median duration of DS resolution in patients receiving ATRA/ATO only was 17 days (n = 23), and in patients receiving combination therapy was 8 days (n = 16) (P = 0.0001). The lengths of hospital stay in patients receiving ATRO/ATO only was 38 days (n = 7), and in patients receiving combination therapy was 14 days (n = 17) (P = 0.0007). In conclusion, adding adjuvant chemotherapy to ATRA/ATO only protocol may reduce the duration of DS and the length of hospital stay during APL induction treatment.

Original languageEnglish (US)
Article number911745
JournalFrontiers in Oncology
StatePublished - Aug 3 2022


  • Acute Promyelocytic Leukemia
  • Adjuvant Chemotherapy
  • All-Trans-Retinoic Acid (ATRA)
  • Arsenic Trioxide (ATO)
  • Differentiation Syndrome (DS)

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


Dive into the research topics of 'The role of adjuvant chemotherapy in the management of acute promyelocytic leukemia differentiation syndrome'. Together they form a unique fingerprint.

Cite this