[Therapies for newly diagnosed acute promyelocytic leukemia]

All-trans retinoic acid (ATRA) in combination with chemotherapies had been the standard therapy for newly diagnosed acute promyelocytic leukemia (APL). In Japan, APL204 study using ATRA+chemotherapy showed favorable outcomes, in which 7-year event-free and overall survival rates were 79% and 87%, respectively. Recently, a combination of ATRA and arsenic trioxide (ATO) has emerged as a promising therapy for newly diagnosed APL. Specifically, for patients with standard-risk APL with an initial white blood cell count (WBC) of <10,000/µl, two randomized controlled trials showed superior outcomes using ATRA+ATO to ATRA+chemotherapy, with long-term survival rates above 90%. Now ATRA+ATO is considered as an established standard therapy for newly diagnosed patients with standard-risk APL. Some prospective studies have also showed the efficacies of ATRA+ATO in patients with high-risk APL with an initial WBC of >10,000/µl although the administration of gemtuzumab ozogamicin or idarubicin was required in addition to ATRA+ATO during induction therapy. This review briefly summarizes the findings of ATRA+chemotherapy, focusing on the APL204 study, and introduces trials of ATRA+ATO for newly diagnosed APL. Furthermore, it describes the management of complications, including disseminated coagulation and differentiation syndrome.