Progress in the treatment of acute promyelocytic leukemia: optimization and obstruction.

The past three decades have witnessed a great progress in the treatment of acute promyelocytic leukemia (APL). The current application of all-trans retinoic acid, arsenic trioxide (ATO), and anthracycline-based chemotherapies has been proved to be highly effective. Based on the risk factors of APL, optimization of the treatment emphasizes the role of ATO in induction, consolidation and maintenance therapy as a substitute to chemotherapy in low- and intermediate-risk patients, and in potential reduction of chemotherapy in high-risk group without impact on the outcome. However, early death and relapse remain obstacles to further improvement of the rates of remission and long-term survival, and the acute and chronic adverse effects of ATO should be considered for more appropriate management. Efforts should be made to more rationally obtain improved outcomes through the use of less toxic regimens.