Treatment of Acute Promyelocytic Leukemia

To the Editor: Lo-Coco et al. (July 11 issue) 1 report that a combination of all- trans retinoic acid (ATRA) and arsenic trioxide as an induction and consolidation therapy was not inferior and was possibly superior to ATRA plus chemotherapy in patients with low-to-intermediate-risk acute promyelocytic leukemia (APL). 1 It is notable that the advantage of ATRA plus arsenic trioxide therapy was mainly its lower mortality from toxicity. We assume that the advantage of the less toxic regimen might be larger in elderly patients with APL, since an older age remains a prominent negative prognostic factor because of the high death rate . . .