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Mediterr J Hematol Infect Dis. 2014 Apr 15;6(1):e2014032. doi: 10.4084/MJHID.2014.032. eCollection 2014.

Acute Promyelocytic Leukemia (APL): Comparison Between Children and Adults.

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  • 1Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Italy.
  • 2Department of Pediatric Hemato-Oncology, IRCCS Ospedale Bambino Gesù, Roma University of Pavia, Italy.
  • 3Department of Pediatric Hemato-Oncology, University of Bologna, Italy.
  • 4Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy ; Laboratory of Neuro-Oncoematology, Santa Lucia Foundation, Rome, Italy.


The outcome of adults and children with Acute Promyelocytic Leukemia (APL) has dramatically changed since the introduction of all trans retinoic acid (ATRA) therapy. Based on the results of several multicenter trials, the current recommendations for the treatment of patients with APL include ATRA and anthracycline-based chemotherapy for the remission induction and consolidation, and ATRA combined with low-dose chemotherapy for maintenance. This has improved the prognosis of APL by increasing the complete remission (CR) rate, actually > 90%, decreasing the induction deaths and by reducing the relapse rate, leading to cure rates nowadays exceeding 80% considering both adults and children.1-9 More recently the combination of ATRA and arsenic trioxide (ATO) as induction and consolidation therapy has been shown to be at least not inferior and possibly superior to ATRA plus chemotherapy in adult patients with APL conventionally defined as non-high risk (Sanz score).10 Childhood APL has customarily been treated on adult protocols. Data from several trials have shown that the overall outcome in pediatric APL appears similar to that reported for the adult population; however, some clinical and therapeutic aspects differ in the two cohorts which require some important considerations and treatment adjustments.

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