All-trans retinoic acid (ATRA) can induce complete remission (CR) in most patients with
acute promyelocytic leukemia (APL) through in vivo differentiation of APL-blasts. However, it cannot eliminate the leukemic clone and must be used in combination with
anthracycline-based
chemotherapy. Experience accumulated over the last 10 years has clearly shown that the combination of ATRA and
chemotherapy gave better survival than
chemotherapy alone in newly diagnosed APL because of fewer relapses and a slightly higher CR rate. It is also strongly suggested that maintenance treatment with ATRA, and possibly with low-dose
chemotherapy, can further reduce the incidence of relapse. Overall, more than 90% of patients with newly diagnosed APL can achieved CR, and about 75% can be cured by the combination of ATRA and
chemotherapy. ATRA syndrome remains the major side effect of ATRA treatment, which should be prevented by addition of
chemotherapy and/or
dexamethasone in case of increasing white blood cell (WBC) counts. Current issues in the treatment of newly diagnosed APL include the role of early addition of
chemotherapy to ATRA, whether or not
ara-C is useful in combination with
anthracycline, and a possible interest of
arsenic trioxide during consolidation in patients remaining at relatively high risk of relapse.