Abstract
Introduction: Acute promyelocytic leukemia (APL) is characterized by a reciprocal translocation between chromosomes 15 and 17 yielding the PML-RARA fusion gene, which deregulates cell proliferation and blocks granulocyte differentiation. All-trans retinoic acid (ATRA) dramatically improved the prognosis of APL, but relatively, small number of relapsing patients achieves second remission with ATRA alone.
Areas covered: Tamibarotene, a new synthetic retinoid, is about 10 times more potent than ATRA, chemically more stable than ATRA, with low affinity for cellular RA-binding protein and no detectable binding to RA receptor-γ. Tamibarotene has a significant effect on ATRA-resistant APLs. Some arsenic trioxide (ATO) and gemtuzumab ozogamicin-resistant APLs are reportedly tamibarotene-sensitive.
Expert opinion: Tamibarotene was tested in APL-relapsed patients after ATRA-induced complete remission (CR), and 14/24 patients (58%) achieved CR. In an independent trial, 24/39 (61.5%) APL patients achieved CR including 5 newly diagnosed patients and 13 patients who had relapsed twice or more. A prospective randomized study compared tamibarotene with ATRA as maintenance therapy. Four-year relapse-free survival rate was 84% (ATRA) and 91% (tamibarotene) (p = 0.095). In high-risk patients, this became significant (58% ATRA, 87% tamibarotene, p = 0.028). These results suggest tamibarotene should be tested in induction or consolidation therapy and in combination with ATO.
Acknowledgments
We thank the Japan Adult Leukemia Study Group (JALSG) members who provided data.