Acute promyelocytic leukemia maintenance therapy

Treatment of acute promyelocytic leukemia consists of induction therapy, followed by consolidation and maintenance therapy. Induction includes tretinoin and an anthracycline consolidation therapy consists of two to three cycles of anthracycline-based therapy maintenance consists of pulse doses of tretinoin, mercaptopurine, and methotrexate for 2 years. 

Eenaux P, Chastang C, Chevret S, et al. A randomized comparison of all-trans-retinoic acid (ATRA) followed by chemotherapy and ATRA plus chemotherapy and the role of maintenance therapy in newly diagnosed acute promyelocytic leukemia. Blood 1999 94 1192-1200. 

Tallman, M. S., Andersen, J., Schiffer, C A, Appelbaum, F R, Feusner, J E, Woods, W G, Ogden, A., Weinstein, H, Shepherd, L, Rowe, J. M., and Wiernik, P. H. (1995) Phase III randomized study of all-trans retinoic acid (ATRA) vs daunorubicin (D) and cytosine arabmoside (A) as induction therapy and ATRA vs observation as maintenance therapy for patients with previously untreated acute promyelocytic leukemia (APL). Blood 86, Suppl 1,125a. 

A 38-year-old man with acute promyelocytic leukemia who was taking itraconazole 200 mg bd was given all-trans retinoic acid and during the third course of maintenance therapy developed acute renal insufficiency and symptomatic hypercalcemia, which was treated with high-volume crystalloid infusions and furosemide. Renal function was restored, and the serum calcium concentration returned to normal within 4 days after withdrawal of ATRA. The peak serum calcium concentration was 3.67 mmoUl. Serum parathyroid hormone was undetectable, and there were no increases in the concentrations of prostaglandins or vitamin D metabolites. Hypercalcemia recurred during a fourth course of ATRA. 

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