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Systemic Anti-Cancer Therapy Regimen Library

LEU APL - APML4 induction, consolidation 1 and 2 followed by maintenance [60 years and under]

Treatment Overview

This regimen is intended for those 60 years and under.

It consists of 4 parts:

  1. Induction
  2. Consolidation 1
  3. Consolidation 2
  4. Maintenance for 8 cycles.

Each part follows 3 to 4 weeks after the completion of the previous part.

APML4 [60 years and under] - Induction

Followed 3 to 4 weeks after completion by:

APML4 [60 years and under] - Consolidation 1

Followed 3 to 4 weeks after completion by:

APML4 [60 years and under] - Consolidation 2

Followed 3 to 4 weeks after completion by:

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Variable
Antiviral prophylaxis for herpes virus: Variable
Emetogenicity: Variable
Gastroprotection: Variable
Tumour lysis syndrome prophylaxis: Variable

Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.

References

Iland, H. J., K. Bradstock, S. G. Supple, et al. 2012. "All-trans-retinoic acid, idarubicin, and IV arsenic trioxide as initial therapy in acute promyelocytic leukemia (APML4)." Blood 120(8):1570-1580; quiz 1752., PMID: 22715121

Coutre, S. E., M. Othus, B. Powell, et al. 2014. "Arsenic trioxide during consolidation for patients with previously untreated low/intermediate risk acute promyelocytic leukaemia may eliminate the need for maintenance therapy." Br J Haematol 165(4):497-503., PMID: 24528179

NCCN Clinical Practice Guidelines in Oncology - Acute Myeloid Leukemia - Version 2.2022 www.nccn.org

Phebra NZ Limited Phenasen® New Zealand data sheet 23 July 2019 https://www.medsafe.govt.nz/profs/datasheet/p/phenaseninj.pdf (accessed 15 July 2022).

Pharmaco (NZ) Ltd Vesanoid® New Zealand data sheet 21 April 2022 https://www.medsafe.govt.nz/profs/datasheet/v/Vesanoidcap.pdf (accessed 15 July 2022).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.