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Realgar-Indigo Naturalis Formula (RIF) is an oral form of arsenic that is effective against acute promyelocytic leukemia (APL). This multicenter, randomized, controlled trial compared the efficacy of all-trans retinoic acid (ATRA) plus RIF with ATRA plus arsenic trioxide (ATO) in a simplified regimen for non-high-risk APL. Following induction therapy with ATRA and ATO, participants were randomly assigned to receive either ATRA plus ATO or ATRA plus RIF both in a 2-week on 2-week off schedule for consolidation therapy. Once achieving molecular complete remission, the regimen was administered for a total of 6 cycles. All of 108 eligible patients achieved hematological complete remission after induction therapy. The median follow-up time was 29 months. The primary endpoint of two-year disease-free survival was 97% in the ATRA-RIF arm and 98% in the ATRA-ATO arm, respectively. (The ATRA-RIF arm was found to be non-inferior to the ATRA-ATO arm, (P < .01), with a percentage difference of -1% (95%CI, -4.8 to 6.9). No deaths have been observed. Most adverse events were moderate. This study confirms the noninferiority of RIF to ATO for non-high-risk APL, while also offering a more favorable regimen schedule for post-remission therapy. (ClinicalTrials gov. Identifier: as NCT02899169).

Background: A patient with acute myeloid leukemia (AML) presented with a cardiac mass of unknown nature. This case underscores the importance of careful monitoring and a multidisciplinary approach in managing and differentiation of rare cardiac complications in leukemia patients. It aims to improve diagnostic accuracy and therapeutic outcomes in similar challenging scenarios. This case report discusses a 33-year-old male who was initially diagnosed with Acute Myeloid Leukemia (AML). During medical check-ups before allogeneic hematopoietic stem cell transplant (allo-HSCT), cardiac ultrasound revealed several mobile and homogenous masses of unidentified nature in his right atrium and right ventricle. The lesions presented gradually increasing calcification of the capsule, the nature of these masses remains unknown. Case presentation: The patient was diagnosed with Acute Myeloid Leukemia and achieved complete remission following multiple chemotherapy cycles. From a leukemia treatment perspective, an allo-HSCT was needed as soon as possible. However, several masses were found in his right heart before the transplant. A series of tests were performed to determine the nature of the cardiac mass. His echocardiograms and MRI revealed persistent mobile and nodular masses with a calcified capsule in the right atrium and right ventricular lateral wall, and no signals changes of the mass between MRI first-pass perfusion and delayed enhancement. Which complicated the differential diagnosis. Finally, considering the need for leukemia treatment, allo-HSCT was performed after extensive workup, including echocardiography, MRI, and PET/CT, which ruled out leukemic infiltration, typical infectious vegetation, and primary or metastatic cardiac tumors. The cardiac masses were first discovered during pre-transplant screening in April 2022, approximately 5 months after initial AML diagnosis in November 2021. At present, more than 2 years after transplantation, follow-up imaging examination of the masses revealed gradually increasing calcification, but of a still unknown nature. Conclusions: The case of this 33-year-old male with AML and concomitant cardiac masses highlights a complex challenge in his diagnosis and treatment. Despite extensive imaging and multidisciplinary consultations, including echocardiography, MRI, and PET/CT, the exact nature of these calcified, mobile nodular masses in the right atrium and right ventricular lateral wall remains elusive. Their persistence and atypical imaging characteristics underscore the need for continued research and collaboration to elucidate their underlying pathology. [ABSTRACT FROM AUTHOR]