new dx of APL, started on ATRA, in DIC and differentiation s | Figure 1

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new dx of APL, started on ATRA, in DIC and differentiation syndrome, with alveolar hemorrhages, gi bleed, non-aneurysmal sah, and micro emboli? to extremities.

Cochrane Review; Summary of Evidence

Cochrane Review; eight studies (almost 4000 patients), comparing chemotherapy in combination with all‐trans retinoic acid (ATRA) with chemotherapy alone in adult patients with acute myeloid leukaemia (AML). Participants with acute promyelocytic leukaemia (APL) were not evaluated.

Key messages

• The addition of ATRA to chemotherapy did not show differences in terms of overall survival (moderate certainty evidence).
• Subgroup analyses showed there is potential benefit for ATRA in combination with a certain chemotherapeutic called decitabine, for older patients (60+ years) and for patients who already had successful chemotherapy and now receive therapy for maintenance.
• For disease‐free‐survival, complete response rate and on‐study mortality there was probably no or little difference between treatment groups (moderate certainty evidence).
• Rates of toxicities were low, therefore certainty of evidence is 'very low' to 'low' for the adverse events diarrhoea, nausea/vomiting and cardiac toxicity. Currently, it seems the risk of adverse events with additional ATRA are comparable to chemotherapy only (moderate certainty evidence).
• The combination of ATRA probably did not lead to a higher infection rate. Regarding cardiac toxicity and diarrhoea, it is uncertain whether the addition of ATRA is beneficial.
• Quality of life was not reported by any of the trials.