Acute myeloid leukemia
ICD-10 C92.0 · ICD-11 2A60

Treatment of Relapsed or Refractory Acute Promyelocytic Leukaemia

Acute promyelocytic leukaemia (APL) that relapses or proves refractory presents a distinct clinical challenge within the AML spectrum. The treatment strategy depends critically on the nature of prior therapy received and the timing of disease recurrence, with the primary objective being recovery of molecular remission.

Clinical Scenario

This protocol applies to patients with relapsed or refractory acute promyelocytic leukaemia — encompassing those who relapsed following prior chemotherapy-based induction and those experiencing relapse after prior targeted combination regimens, whether early or late in the post-treatment course. CNS involvement is also addressed within this framework.

Treatment Approach

Reinduction and consolidation strategies are recommended, with the specific regimen selected according to the timing of relapse and the patient's prior treatment history. Eligibility for certain therapeutic options further shapes the individualized approach.

Goal: Achievement of second molecular remission
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References

  1. Patients relapsing after ATRA and ChT or relapsing >24 months after the end of ATO/ATRA treatment should receive ATO/ATRA for reinduction and consolidation until achievement of second molecular remission [IV, B].
  2. In the unlikely event of an early relapse (within 24 months) after treatment with ATO/ATRA, we recommend ATRA with ChT or, in patients not eligible for ChT, GO with or without ATO/ATRA [IV, B] (Figure 5).
  3. Treatment of patients with CNS involvement should include ATO, which crosses the blood-brain barrier to some extent (CSF ATO levels were 17.7% of plasma levels).
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