Phase III study of all-trans retinoic acid in previously untreated patients 61 years or older with acute myeloid leukemia: APL

The purpose of our study was (i) to evaluate the impact of all- trans retinoic acid (ATRA) given as adjunct to chemotherapy and (ii) to compare second consolidation vs maintenance therapy in elderly patients with acute myeloid leukemia (AML). A total of 242 patients aged ⩾61 years (median, 66.6 years) with AML were randomly assigned to ATRA beginning on day +3 after the initiation of chemotherapy (ATRA-arm, n =122) or no ATRA (standard-arm, n =120) in combination with induction and first consolidation therapy. A total of 61 patients in complete remission (CR) were randomly assigned to second intense consolidation ( n =31) or 1-year oral maintenance therapy ( n =30). After induction therapy the intention-to-treat analysis revealed a significant difference in CR rates between the ATRA- and the standard-arm (52 vs 39%; P =0.05). Event-free (EFS) and overall survival (OS) were significantly better in the ATRA-compared to the standard-arm ( P =0.03 and 0.01, respectively). OS after second randomization was significantly better for patients assigned to intensive consolidation therapy ( P