ASH International Committee Acute Promyelocytic Leukemia Protocol (IC-APL2006).
| Remission Induction (all patients) . | DNR 60 mg/m2/day (days 2,4,6 and 8)* ATRA 45 mg/m2/day§ (day 1 until CR) Dexamethasone 2.5 mg/m2/12h × 15 (if WBC > 5 × 109/L) . | |||
|---|---|---|---|---|
| . | . | . | High-Risk (WBC >10 × 109/L Platelets ≤ 40 × 109/L) . | |
| Consolidation (risk-adapted) . | Low-risk (WBC ≤ 10 × 109/L Platelets > 40 × 109/L) . | Intermediate-Risk (WBC ≤ 10 × 109/L Platelets ≤ 40 × 109/L) . | ≥ 60 years old . | < 60 years old . |
| Abbreviations: ATRA, all-trans retinoic Acid; DNR, daunorubicin; MTZ, mitoxantrone; Ara-C, cytarabine; CR, complete remission. | ||||
| *Patients > 70 years old receive only three doses of daunorubicin (days 2, 4, and 6) during induction. | ||||
| §In patients < 20 years old, the ATRA dose is reduced to 25 mg/m2/day given in 2 doses. | ||||
| DNR 25 mg/m2/day (days 1,2,3,4) | DNR 35 mg/m2/day (days 1,2,3,4) | DNR 35 mg/m2/day (days 1,2,3,4) | DNR 25 mg/m2/day (days 1,2,3,4) | |
| ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | Ara-C 1000 mg/m2/day (days 1,2,3,4) ATRA 45 mg/m2/day × 15 | |
| MTZ 10 mg/m2/day (days 1,2,3) | MTZ 10 mg/m2/day (days 1,2,3) | MTZ 10 mg/m2/day (days 1,2,3) | MTZ 10 mg/m2/day (days 1,2,3,4,5) | |
| ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | |
| DNR 60 mg/m2/day (day 1) | DNR 60 mg/m2/day (days 1,2) | DNR 60 mg/m2/day (days 1,2) | DNR 60 mg/m2/day (day 1) | |
| ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | Ara-C 150 mg/m2/8 h (days 1,2,3,4) ATRA 45 mg/m2/day × 15 | |
| Maintenance (all patients) | 2 years ATRA 45 mg/m2/day × 15 (every 3 months) Methotrexate 15 mg/m2/day (weekly) 6-Mercaptopurine 50 mg/m2/day | |||
| Remission Induction (all patients) . | DNR 60 mg/m2/day (days 2,4,6 and 8)* ATRA 45 mg/m2/day§ (day 1 until CR) Dexamethasone 2.5 mg/m2/12h × 15 (if WBC > 5 × 109/L) . | |||
|---|---|---|---|---|
| . | . | . | High-Risk (WBC >10 × 109/L Platelets ≤ 40 × 109/L) . | |
| Consolidation (risk-adapted) . | Low-risk (WBC ≤ 10 × 109/L Platelets > 40 × 109/L) . | Intermediate-Risk (WBC ≤ 10 × 109/L Platelets ≤ 40 × 109/L) . | ≥ 60 years old . | < 60 years old . |
| Abbreviations: ATRA, all-trans retinoic Acid; DNR, daunorubicin; MTZ, mitoxantrone; Ara-C, cytarabine; CR, complete remission. | ||||
| *Patients > 70 years old receive only three doses of daunorubicin (days 2, 4, and 6) during induction. | ||||
| §In patients < 20 years old, the ATRA dose is reduced to 25 mg/m2/day given in 2 doses. | ||||
| DNR 25 mg/m2/day (days 1,2,3,4) | DNR 35 mg/m2/day (days 1,2,3,4) | DNR 35 mg/m2/day (days 1,2,3,4) | DNR 25 mg/m2/day (days 1,2,3,4) | |
| ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | Ara-C 1000 mg/m2/day (days 1,2,3,4) ATRA 45 mg/m2/day × 15 | |
| MTZ 10 mg/m2/day (days 1,2,3) | MTZ 10 mg/m2/day (days 1,2,3) | MTZ 10 mg/m2/day (days 1,2,3) | MTZ 10 mg/m2/day (days 1,2,3,4,5) | |
| ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | |
| DNR 60 mg/m2/day (day 1) | DNR 60 mg/m2/day (days 1,2) | DNR 60 mg/m2/day (days 1,2) | DNR 60 mg/m2/day (day 1) | |
| ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | ATRA 45 mg/m2/day × 15 | Ara-C 150 mg/m2/8 h (days 1,2,3,4) ATRA 45 mg/m2/day × 15 | |
| Maintenance (all patients) | 2 years ATRA 45 mg/m2/day × 15 (every 3 months) Methotrexate 15 mg/m2/day (weekly) 6-Mercaptopurine 50 mg/m2/day | |||