Discussion
APL, arsenic retention, cardiac toxicity, cardiac adverse, Arsenic retention, alimentary tract hemorrhage, infection
INTRACRANIAL HEMORRHAGE, DISEASE, INFECTION, ADULT APL, PEDIATRIC APL, PULMONARY HEMORRHAGE, RELAPSE
To our knowledge, only one study group (Chinese APL Cooperative Group) has reported multicenter randomized studies comparing RIF and ATO in adult APL [The incidence of infection or FUO was significantly lower in the RIF group. RIF can be taken orally in an outpatient setting when the disease is stable, which decreases the risk of cross-infection in the hospital and iatrogenic infection due to PICC line placement, altogether resulting in shorter hospital stays. Moreover, the total incidence of cardiac adverse events during consolidation tended to be lower in the RIF group than in the ATO group (Treatment intensity can be further reduced in the arsenic and ATRA era, as reported recently that chemotherapy-free treatment was used for patients with NHR APL, and intrathecal may not be required for those without central nervous system leukemia or intracerebral hemorrhage [Arsenic retention is another major concern, especially in children treated with arsenic. To our knowledge, there has been no study comparing arsenic retention in children between treatments with RIF and ATO. A single-arm study investigated arsenic levels in plasma, hair, nail, and urine at different treatment time points in children with APL treated with ATO or RIF, and showed that the arsenic levels of the first three (except urine) returned to normal after 6 months stopping arsenic administration [Relapse is uncommon in APL following contemporary treatment. This study proved that FLT3-ITD mutations are not a risk factor for relapse of pediatric APL, which is in line with the results of recent studies observed in adult patients [Although we obtained an excellent long-term survival rate in our cohort, there were 10 of 195 (5.1%) patients died before randomization. Among them, 8 died of intracranial hemorrhage, 1 intracranial hemorrhage and pulmonary hemorrhage, and 1 alimentary tract hemorrhage (Suppl. Table In conclusion, the final results of the multicenter randomized trial SCCLG-APL confirmed that oral RIF is as effective as intravenous ATO for the treatment of pediatric APL. The substitution of RIF for ATO has the additional advantages of shortened hospital days, less infection risk, and cardiac toxicity in pediatric patients. Given its advantage over ATO in treating APL patients across all age groups, promoting the wider use of oral RIF outside of China is worthwhile.