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Systemic Anti-Cancer Therapy Regimen Library

LEU APL - Pethema LPA2005 induction and consolidations 1, 2 and 3 followed by maintenance [70 years and under] [intermediate risk]

Treatment Overview

This regimen is intended for those 70 years and under with intermediate risk disease. Intermediate risk group includes patients with a white cell count 10 x 109/L or lower and platelets count 40 x 109/L or lower at presentation.

It consists of 5 parts:

  1. Induction, followed after count recovery by
  2. Consolidation 1, followed after count recovery by
  3. Consolidation 2 followed after count recovery by
  4. Consolidation 3, followed 1 month after count recovery by
  5. Maintenance for 8 cycles.

Count recovery is defined as:

  • Neutrophils greater than 1.5 × 109/L.
  • Platelets greater than 100 × 109/L.

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Variable
Antiviral prophylaxis for herpes virus: Variable
Emetogenicity: Variable
Gastroprotection: Variable
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: 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

Pethema LPA 2005/ HOVON 79 APL Protocol HOVON version: March 30, 2006. http://www.hematologie-amc.nl/bestanden/hematologie/studieprotocollen/HOVON79/ho79-pro.pdf (accessed 19 July 2022).

Sanz MA, Montesinos P, Rayón C, Holowiecka A, de la Serna J, Milone G, de Lisa E, Brunet S, Rubio V, Ribera JM, Rivas C, Krsnik I, Bergua J, González J, Díaz-Mediavilla J, Rojas R, Manso F, Ossenkoppele G, González JD, Lowenberg B; PETHEMA and HOVON Groups. Risk-adapted treatment of acute promyelocytic leukemia based on all-trans retinoic acid and anthracycline with addition of cytarabine in consolidation therapy for high-risk patients: further improvements in treatment outcome. Blood. 2010 Jun 24;115(25):5137-46. doi: 10.1182/blood-2010-01-266007. Epub 2010 Apr 14., PMID: 20393132

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).

Baxter Healthcare Ltd ONKOTRONE Data sheet 22 October 2020 https://www.medsafe.govt.nz/profs/datasheet/o/Onkotroneinj.pdf (accessed 11 July 2022).

Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.

* 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.