Is cytarabine required in the treatment of acute promyelocytic leukemia?

Until the late 1980s, chemotherapy with anthracyclines and cytarabine (AraC) was the only treatment approach for acute promyelocytic leukemia (APL), as for other types of acute myeloid leukemia. Many studies have shown that treatment with all-trans retinoic acid (ATRA), followed by anthracycline-AraC chemotherapy, significantly decreases the incidence of relapse and improves survival in newly diagnosed APL, compared with this chemotherapy alone. This approach was associated with consistent morbidity and mortality during consolidation and maintenance treatment, however, mainly resulting from myelosuppression induced by anthracycline-AraC courses. Several groups have reported high rates of complete remission and low rates of relapse with ATRA and chemotherapy using anthracyclines alone, suggesting that AraC could be avoided in the chemotherapy of APL, reducing toxicity. These results were not confirmed in other studies, however, raising the issue of the role of AraC in treatment of patients with newly diagnosed APL.