Safety and efficacy of different doses of anthracyclines combined with arsenic trioxide and all-trans retinoic acid in the treatment of de novo acute promyelocytic leukemia.

Objectives: The purpose of this study was to evaluate the efficacy and safety of different doses of anthracyclines combined with arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) for induction in newly diagnosed acute promyelocytic leukemia (APL).

Methods: One hundred and forty patients were included between January 2011 and December 2017. Seventy patients received low dose anthracycline, ATO and ATRA for induction chemotherapy; and other seventy patients received standard dose anthracycline, ATO and ATRA for induction chemotherapy.

Results: The outcomes of both groups were similar: low dose group versus standard dose group: early mortality 5.7% vs. 10.0% ( = 0.532), disease-free survival (DFS), probabilities of overall-survival (OS) at 2 years 94.6% vs. 95.1% ( = 0.657), 92.8% vs. 88.2% ( = 0.951), respectively. However, the standard-dose group was associated with a longer duration of neutropenia ( < 0.001) and thrombocytopenia ( < 0.001), more volumes of platelets ( = 0.037) and red blood cell transfusions ( < 0.001), and a higher rate of infections ( = 0.042).

Conclusion: Low-dose group achieves outcomes similar to those of standard dose group for APL patients, but the low-dose group may be even safer than standard-dose group. So the low-dose anthracycline may be a better choice for newly diagnosed APL patients.