Treatment of Refractory and Relapsed APL

The prognosis of acute promyelocytic leukemia (APL) has improved significantly during the last few decades. Relapses have become quite rare, and although cure may still be possible after relapse, the optimal management of the individual patient is a major challenge. Arsenic trioxide (ATO)-based salvage therapy is the treatment of choice after frontline therapy with all-trans-retinoic acid (ATRA) and chemotherapy. Current data suggest autologous or allogeneic stem cell transplantation after re-induction of remission depending on the individual risk profile. Patients not qualifying for transplantation probably benefit from prolonged application of ATO. Even after frontline therapy with ATO, salvage therapy with ATO may still be effective. This chapter gives an overview on the currently available treatment options for relapsed APL, as well as on prognostic factors, which may influence the relapse management in the individual patient.