Zhu Hong-Hu
Department of Hematology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Oncol. 2020 Nov 16;10:592996. doi: 10.3389/fonc.2020.592996. eCollection 2020.
Acute promyelocytic leukemia (APL) has become a highly curable disease after four decades of endeavors. Thanks to the efforts of investigators throughout the world, the chemo-free concept has become a reality for both low- and high-risk patients. All-trans retinoic acid (ATRA) plus arsenic trioxide (ATO) without chemotherapy has become a first-line treatment for newly diagnosed APL and has been adopted in guidelines or expert recommendations from the NCCN and ELN and in China. Though the regimen has achieved great success, challenges still exist. The rate of early death still has not diminished significantly and is a major obstacle to curing all patients. Leukocytosis is the most important factor for ED, and completely abandoning chemotherapy is dangerous for certain patients in practice. To narrow the gap between guidelines and practice, this review aims to examine the history of the chemo-free model for the treatment of APL in the arsenic-alone era (1974-2002) and the arsenic plus ATRA era (2002-present) and provide practical considerations regarding early death.
经过四十年的努力，急性早幼粒细胞白血病（APL）已成为一种高度可治愈的疾病。得益于世界各地研究人员的努力，无化疗理念已成为低风险和高风险患者的现实。全反式维甲酸（ATRA）联合三氧化二砷（ATO）无需化疗已成为新诊断APL的一线治疗方案，并已被美国国立综合癌症网络（NCCN）、欧洲白血病网（ELN）以及中国的指南或专家推荐所采用。尽管该方案取得了巨大成功，但挑战依然存在。早期死亡率仍未显著降低，这是治愈所有患者的主要障碍。白细胞增多是早期死亡的最重要因素，在实践中完全放弃化疗对某些患者来说是危险的。为了缩小指南与实践之间的差距，本综述旨在回顾在仅使用砷剂的时代（1974 - 2002年）和砷剂加ATRA时代（2002年至今）治疗APL的无化疗模式的历史，并提供有关早期死亡的实际考量。
