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This letter discusses the impact of treatment for Acute Promyelocytic Leukemia (APL) with Arsenic Trioxide (ATO) and All-trans Retinoic Acid (ATRA) on fertility. The authors conducted a retrospective study at a tertiary care institute in North India, focusing on patients between the ages of 18 and 40 who had completed therapy and were in molecular remission. Out of the 60 patients included in the study, 11 patients (19.3%) successfully conceived children post-therapy without the use of fertility therapy, and no adverse pregnancy outcomes or congenital abnormalities were reported. The study suggests that ATO treatment for APL does not appear to decrease fertility in patients. [Extracted from the article]

Summary: Arsenic trioxide (ATO) and all‐trans retinoic acid (ATRA) form the backbone of the treatment of acute promyelocytic leukaemia (APL), with the addition of chemotherapy for high‐risk patients. We describe our experience of treating patients with APL of all risk classes with ATO and ATRA without chemotherapeutic agents. Patients received induction with ATO and ATRA followed by three cycles of consolidation with ATO and ATRA (each 1 month apart) after achieving morphological remission. Patients with intermediate‐ and high‐risk disease received a further 2 years of maintenance with ATRA, 6‐mercaptopurine and methotrexate. A total of 206 patients were included in the study. The majority of the patients were intermediate risk (51.9%), followed by high risk (43.2%). Differentiation syndrome was seen in 41 patients (19.9%). Overall, 25 patients (12.1%) died within 7 days of initiating therapy. Seven patients relapsed during follow‐up. The mean (SD) estimated 5‐year event‐free survival (EFS) and overall survival (OS) in the entire cohort was 79% [5.8%] and 80% [5.8%] respectively. After excluding patients who died within 7 days of therapy initiation, the mean (SD) estimated 5‐year EFS and OS was 90% [5.8%] and 93% [3.9%] respectively. Our study shows that treatment of all risk classes of APL with ATO and ATRA without chemotherapy is associated with excellent long‐term outcomes in the real‐world setting. [ABSTRACT FROM AUTHOR]

The article focuses on a study which described the safety and efficacy of high-dose hydroxyurea (HDH) for cytoreduction in acute promyelocytic leukemia (APL). Ultra-high-risk patients with APL were analyzed between 2016 and 2021. It was observed that study participants who received HDH has lower early mortality and that none of them developed mucositis. Overall survival of the patients were compared using the Kaplan-Meier technique.

Acute Promyelocytic Leukemia (APL) is associated with excellent long-term outcomes. However, early mortality due to coagulopathy remains a challenge. In this study we examined the bleeding and thrombotic manifestations, as well as incidence of Early Death secondary to thrombosis/hemorrhage (ED-TH) in patients with APL. Early death (ED) was defined as death occurring within 30 days of induction therapy. Two-hundred forty-eight patients were included in the study. Overall, 57 patients had evidence of a major bleed/thrombosis at presentation or during induction therapy, including 44 patients with a major bleed, 8 patients with thrombosis and 5 patients with both evidence of thrombosis and a major bleed. Forty patients (16.1%) had ED, of which 21 had ED-TH. The cumulative incidence of death due to thrombo-hemorrhagic complications at 30 days was 8.4%. On univariate analysis, increasing Prothrombin time (PT)(p-<0.001), white blood cell count (p < 0.001) and activated Partial thromboplastin time (aPTT) (p < 0.001) were statistically significantly associated with increased risk of ED-TH. However, on multivariate analysis, only increasing PT (p-0.025) and aPTT (p-0.041) were significantly associated with increased risk of ED-TH. • Bleeding/Thrombosis is majorly responsible for early death in Acute Promyelocytic Leukemia (APL). • Factors associated with early death due to bleed/thrombosis (ED) in APL patients were analysed. • Prothrombin Time and activated partial thromboplastin time were associated with increased risk of ED. • Better predictors of ED may help improve outcomes further in patients with APL. [ABSTRACT FROM AUTHOR]