Newly diagnosed acute promyelocytic leukaemia (APL), low to intermediate risk (WBC ≤10,000 per microliter)
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Induction (1 cycle) | |||
| Arsenic trioxide | 0.15 mg/kg once daily | IV | Daily until bone marrow remission (maximum 60 days) |
| Tretinoin | 22.5 mg/m² twice daily (45 mg/m² per day) | Oral | Daily until bone marrow remission (maximum 60 days) |
| Consolidation (4 cycles of 8 weeks) | |||
| Arsenic trioxide | 0.15 mg/kg once daily | IV | 5 days per week, Weeks 1–4 of each 8-week cycle |
| Tretinoin | 22.5 mg/m² twice daily | Oral | Weeks 1, 2, 5 and 6 of each 8-week cycle (Weeks 5 and 6 are omitted in the fourth cycle) |
Differentiation syndrome prophylaxis with prednisone 0.5 mg/kg per day from Day 1 until the end of induction. If differentiation syndrome occurs: temporarily withhold arsenic trioxide (and, in severe cases, tretinoin), give dexamethasone 10 mg IV every 12 hours for at least 3 days and until symptoms resolve, then resume at 50% of the dose. ECG before starting and weekly; keep potassium above 4 mEq/L and magnesium above 1.8 mg/dL; QTc above 450 ms (men) or 460 ms (women): interrupt and resume at half the dose after correction. Hepatotoxicity (bilirubin more than 3 times, or AST or ALP more than 5 times the upper limit of normal): interrupt and resume at 50% of the dose. During induction, coagulation tests, blood counts and blood chemistry at least 2 to 3 times per week. The tretinoin dose is rounded to the nearest 10 mg.
On the page “Leukaemia” · Regimen and dosing in acute promyelocytic leukaemia (APL)