Running Head: LITERATURE REVIEW 1

Literature Review

Name

Professor

Institution

Course

Date
LITERATURE REVIEW 2

Acute promyelocytic leukemia (APL) is the most curable type of Leukemia, and it is a

form of acute myeloid leukemia, which is a type of cancer in blood found in tissues or the bone

marrow. Healthy bone marrow contains red blood cells used to distribute oxygen around the by,

the white blood cells which act as the body immunity and the platelets which helps the body in

blood clotting. On the contrary, in acute promyelocytic leukemia, the immature leukocytes

condense in the tissues. These immature leukocytes are called promyelocytes which overgrows

causing the body to lack enough white blood cells, red blood cells, and platelets, hence making

the body become sick associated with signs and symptoms.

In the review from Cochrane Library, the author state the treatment of the APL consist of

induction and consolidation administration, but there exist a clinical trial of the benefits of

maintenance while treating the APL patients. The authors come up with a study of the efficiency

of enrolling maintenance therapy to this kind of patients (Muchtar et al., 2013). The patient came

up with a review of the effect of maintenance therapy introduced to random patients in their early

diagnosis in their first complete remission (CR) then administered with consolidation and

induction therapy.

The authors did a review of 10 randomized trials of 2072 patients, in which they

concluded. In their results after administering the maintenance therapy, the patients showed great

relief in sickness, but it did not affect the survival rate. Additionally, combining both

chemotherapy and ATRA and compared with all-trans-retinoic acid (ATRA) only, had a

significant effect on the disease freedom but no impact on overall survival. When the patient was

on ATRA prescription had a more substantial chance of enjoying freedom from the disease than

the one without the ATRA (Muchtar et al., 2013). However, they did not affect overall survival.

The review also came out with that maintenance therapy in comparison with observation,
LITERATURE REVIEW 3

maintenance with ATRA, and chemotherapy to be toxic than when applying ATRA alone. The

danger form chemotherapy, ATRA and maintenance are associated with hindering the patients

from responding to the medication.

The study shows that the use of both ARTA and maintenance therapy to the early APL

patients, is an added advantage, which can help the patient feel freeform the disease; however, it

may not affect their survival rate. Furthermore, the medication associates with some cons such as

adding of toxics to the cancer patient.

In an article by Ravandi et al., they think ARTA as a significant advancement in cancer

treatment. In their study, it is seen that the patients can reach CR within 30 days, and there is no

need for more GO to counter-attack any prolonged molecular illness. However, the ARTA is

seen affecting the patients by being toxic; the patent on maintenance can result in severe cardiac

events and differentiation syndrome. Hence, there is, when the patients showcase such illness.

Still, the condition is controllable by the addition of corticosteroids.

Ravandi et al. (2013)discuss that APL is now controllable, with the use of maintenance,

the disease has ceased to be fatal to a nearly curable disease. ATRA regimen has added the

survival rate to the patient with cancer, in a probability of 75% can survive for about five years.

Still, it can monitor the patients, the molecular markers of disease, maintenance has helped in

detect any relapse at the earliest time possible. However there is the need for minimizing toxic

which can be associated with cytotoxic chemotherapy to advance the APL treatment, the health

advancement improves at a rate of about 15%v to 20%.

Yamamoto at al., discuss how maintenance has improved the APL treatment, more so,

combing ATRA with chemotherapy for best outcomes in treating APL patients. Hence these
LITERATURE REVIEW 4

makes the use of maintenance treatment in APL a debatable issue, prior administering

consolidation (Yamamoto et al., 2015). The study researched cancer patient with low-to-

intermediate-risk. These patients are later administered with consolidating and inductions

therapy combined with ATRA and anthracyclines. Seven patient ware treated in combining

maintenance while two others were cut short form the maintenance treatment within two

months.in their discussion the authors show that one patient surfed relapsing of APL, one of the

patients who did not receive maintenance therapy. This study concluded that the patient who

received a combination of both chemotherapy and maintenance had a survival rate of 5 years,

which was 100% sure while the patient without maintenance could have a survival rate of 85.7%

of living five years.

The authors discovered that maintenance, however never improved anything regarding

the overall survivor rate, but it is advantageous to the patient concurrent time. Maintenance,

however, was associated with deadly infection, the two patients were dismissed form

maintenance after the developed myelosuppression and infection.

From the studies, it is clear that maintenance adds some value to the APL treatment;

however, it is also associated with some cons. Combination of chemotherapy with ATRA has

shown great advancement in treating APL, its cure rate is over 80%, but the procedure can result

to be toxic to the patients who can even result in the formation of secondary leukemias. Arsenic

Trioxide(ATO) helps in reversing the chemotherapy intensity; hence when combined with

ATRA and chemotherapy can be vital in improving patient wellbeing. Death before or within the

start of newly diagnosed APL therapy remains as the only barrier which prevents its cure. Hence

there is the need for more researches, more so in the laboratories which will help curb tense

hemorrhage. However, the use of ATO can be an advantage when combing maintenance with
LITERATURE REVIEW 5

chemotherapy, which can be administered by the i.v. when administering ARTA, hence,

preventing any future infections from the treatment process.

LITERATURE REVIEW 6

References

Muchtar, E., Vidal, L., Ram, R., Gafter‐Gvili, A., Shpilberg, O., & Raanani, P. (2013). The role

of maintenance therapy in acute promyelocytic leukemia in the first complete

remission. Cochrane Database of Systematic Reviews, (3).

Ravandi, F., Estey, E., Jones, D., Faderl, S., O'Brien, S., Fiorentino, J., ... & Ferrajoli, A. (2009).

Effective treatment of acute promyelocytic leukemia with all-trans-retinoic acid, arsenic

trioxide, and gemtuzumab ozogamicin. Journal of Clinical Oncology, 27(4), 504.

Yamamoto, M., Okada, K., Akiyama, H., Kurosu, T., & Miura, O. (2015). Evaluation of the

efficacy of maintenance therapy for low-to-intermediate-risk acute promyelocytic

leukemia in molecular remission: a retrospective single-institution study. Molecular and

clinical oncology, 3(2), 449-453.