Induction chemotherapy followed by arsenic and all-trans retinoic acid for acute promyelocytic leukemia: Outcomes from a single-center protocol in Singapore

KKH-APML 17 is a single-center protocol for the treatment of pediatric acute promyelocytic leukemia (APML) in Singapore, which commences with standard induction chemotherapy followed by arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) for consolidation. It was designed to reduce anthracycline exposure while maintaining therapeutic efficacy. All three patients treated with this protocol achieved and maintained morphological and molecular remission. Pseudotumor cerebri was an adverse effect of ATRA treatment but no other major adverse effects were observed. In resource-limited settings where ATO is not readily available, this protocol may serve as an interim measure while awaiting the import of ATO.