Combining retinoic acid and oral arsenic may be potentially the first-line therapy for non-high-risk acute promyelocytic leukemia

Once regarded as a rapidly fatal disease, acute promyelocytic leukemia (APL) is now curable in most cases with the use of targeted treatment alone and without chemotherapy (CHT) (1). Platzbecker et al. (2) reported a prospective, randomized, multicenter, open-label, phase III noninferiority trial, which demonstrated the advantages of all-trans-retinoic acid (ATRA) and intravenous ATO over ATRA and CHT with significantly greater and more sustainable antileukemic efficacy over time for non-high-risk APL. The recent paper by Iland et al. (3) also revealed that ATRA and arsenic in initial therapy induction and consolidation for APL reduced the risk of relapse compared with historical controls. These studies demonstrated the advantages of combining ATRA and intravenous ATO over ATRA and CHT for non-high-risk APL.