Successful treatment with arsenic trioxide and retinoic acid for acute promyelocytic leukemia in a very elderly patient 
 
Boulet E 1, Bailly B1. Delrieu V1, Detry G2, Kentos A1, Ngirabacu M.-C1, Ravoet C1, Bettens S3, Van Obbergh F1, Sid S1. Department of Hematology1, Clinical Biology2 and Geriatric3, Jolimont, 7100 La Louvière 
 
 
Objectives:  Chemotherapy free treatment with all-transretinoic-acid (ATRA) and arsenic trioxide (ATO) for promyelocytic acute leukemia (APL) has considerably improved the prognosis of APL, especially in frailer patients who wouldn’t be eligible for conventional chemotherapy.  
 
Methods:  It seemed relevant to report the case of a 90-yearold patient successfully treated with a chemotherapy-free therapy following the 2013 protocol of Lo-Coco1 (ATO 0,15mg/kg/d and ATRA 45mg/m2/d until complete remission). 
 
Results:  After comprehensive geriatric assessment was checked, treatment was started. The ATO dose was reduced by 50% (0.075 mg/kg) given the chronic kidney disease and ATRA was given at a conventional dose of 45 mg/m2.  There were minor complications during induction like grade 1 differentiation syndrome, febrile neutropenia and QTc prolongation. Full blood count normalized on the 26th day, and the marrow aspirate performed showed morphological and cytogenetic remission and a decrease of PMLRARα by RT-PCR at 5,6% from baseline. She received 3 cycles of consolidation. The patient did not present any complication during consolidation treatment. At the end of the treatment, the PML-RARα fusion transcript was undetectable on peripheral blood. 
 
Conclusion:  Treatment with ATRA and ATO was feasible, safe and led to a complete remission even in our very elderly patient diagnosed with acute promyelocytic leukemia. Comprehensive geriatric assessment should always be performed before initiation of the treatment.

Successful treatment with arsenic trioxide and retinoic acid for acute promyelocytic leukemia in a very elderly patient: a case report.