Abstract
Arsenic, a chemical that immediately gets the attention and sometimes strikes fear into the heart of patients and their families is changing the landscape of treatment for acute promyelocytic leukemia (APL). Arsenic trioxide (ATO) is a highly effective treatment for relapsed APL, for which it is US FDA approved. It also has a dramatic impact in patients with newly diagnosed APL, either as part of initial induction therapy or as consolidation therapy for patients in remission. APL: the disease Acute promyelocytic leukemia accounts for approximately 10% of acute myeloid leukemia (AML) cases (~600–800 cases per year) in the USA. APL has well-defined clinical and pathologic features. APL is classified as the M3 subtype of AML in the French American British (FAB) system and classified as APL with t(15;17) (q22;q12), promyelocytic leukemia– retinoic acid receptor-α (PML–RARα) by the WHO. The unique features include a characteristic morphologic appearance with prominent granules and frequent Auer rods [1], often presenting with pancytopenia; however, those with the microgranular variant (M3V) often present with leukocytosis, monocytic appearing nuclei, few or no cytoplasmic granules and absent or rare Auer rods. APL has a younger age of onset compared with other AML subtypes [2], with a high incidence of severe coagulopathy at diagnosis and early hemorrhagic deaths [3,4]. The consumptive
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