The simpler, the better: oral arsenic for acute promyelocytic leukemia

Arsenic trioxide and all-trans retinoic acid have become the frontline treatments for patients with acute promyelocytic leukemia (APL). Despite the long wait for an oral arsenic drug, a commercially available agent, realgar–indigo naturalis formula (RIF), was not launched in China until 2009. Since...

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Bibliographic Details
Published in:Blood 2019-08, Vol.134 (7), p.597-605
Main Authors: Zhu, Hong-Hu, Hu, Jiong, Lo-Coco, Francesco, Jin, Jie
Format: Article
Language:English
Subjects:
Administration, Oral
Antineoplastic Agents - administration & dosage
Antineoplastic Agents - adverse effects
Antineoplastic Agents - pharmacokinetics
Antineoplastic Agents - therapeutic use
Arsenic - administration & dosage
Arsenic - adverse effects
Arsenic - pharmacokinetics
Arsenic - therapeutic use
Arsenic Trioxide - administration & dosage
Arsenic Trioxide - adverse effects
Arsenic Trioxide - pharmacokinetics
Arsenic Trioxide - therapeutic use
Chemical and Drug Induced Liver Injury - etiology
China - epidemiology
Diarrhea - chemically induced
Humans
Leukemia, Promyelocytic, Acute - drug therapy
Leukemia, Promyelocytic, Acute - epidemiology
Leukocytosis - chemically induced
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Summary:Arsenic trioxide and all-trans retinoic acid have become the frontline treatments for patients with acute promyelocytic leukemia (APL). Despite the long wait for an oral arsenic drug, a commercially available agent, realgar–indigo naturalis formula (RIF), was not launched in China until 2009. Since then, over 5000 APL patients have been treated with oral RIF in China. Oral arsenic not only shows a clinical efficacy comparable to that of IV formulations but also displays a better safety profile, improved quality of life, and lower medical costs for patients. The promising results promote incorporating an outpatient postremission therapy model into clinical practice for both low-risk and high-risk APL patients in China. In this review, we discuss the evolution of oral arsenic RIF in the treatment of APL, with a special focus on how to address the related complications during induction therapy.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood.2019000760