All-trans retinoic acid 45 mg/m2 is superior to 25 mg/m2 as the first induction regimen for the treatment of acute promyelocytic leukaemia: a retrospective analysis in a real-world clinical setting

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Acute promyelocytic leukaemia (APL) is a distinctive type of acute myeloid leukaemia (AML), accounting for approximately 10% of AML 1 . All-trans retinoic acid (ATRA) has been used to treat APL in large well-designed clinical trials, which showed that the CR rate and long-term survival increased to 90% based on ATRA combined with arsenic, and the risk of early mortality during induction was only 2.5%~5% 2 , 3 , 4 . However, in the real-world clinical setting, early mortality is still high, with a range of 17–21.8% 4 , 5 , 6 , 7 , 8 . At present, there are two main doses of ATRA used in the world. In most haematology-oncology centres in Europe and the United States, the dosage of ATRA is 45 mg/m 2 /day, while the recommended dosage in China is 25 mg/m 2 /day 9 , 10 , 11 ; both of them have good clinical effects. However, there is no relevant study demonstrating the differences between the two dosages of ATRA. To further clarify whether there is any difference in the clinical efficacy of the two dosages of ATRA for APL, we retrospectively analysed the data of APL patients in our centre in the real-world clinical setting and compared the efficacy between patients administered a dosage of ATRA of 25 mg/m 2 /day (ATRA-25 mg) and those administered a dosage of ATRA of 45 mg/m 2 /day (ATRA-45 mg), with a focus on the occurrence of differentiation syndrome, early death, disease relapse and long-term survival, to provide references for further improving the clinical efficacy of APL.

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