National Guard Health Affairs

King Abdul Aziz Medical City - Riyadh

Department of Oncology- Adult Hematology & HSCT

CHEMOTHERAPY ORDERS

ATRA plus ATO

Induction Phase
For Low Risk APL
Protocol Name / Research No.:
(M3)
Cycle 1
INPATIENT

Diagnosis: Acute Promyelocytic Leukemia ⃞ Induction

Age: …..…Yr Height: ……..cm Weight:……..Kg BSA:………m2 Adjusted BSA:…….… m2

Echocardiogram done ⃞ Yes ⃞ No ⃞ N/A

HYDRATION:

Maintain adequate hydration at least 2-3 L per day, as clinically indicated

PRE-MEDICATIONS / ANTIEMETICS:

□ Allopurinol 300 mg daily for first 14 days starting 24- 48 hours before chemotherapy

CHEMOTHERAPY:

□45mg/m²/day
All Trans Retinoic
PO inAcid
2 equally divided doses rounded to the nearest 10mg from
Day 1 until
(ATRA)
hematologic complete remission or for a maximum of 60 days

0.153mg/kg
□ Arsenic Trioxide
in 100mL 0.9% Sodium Chloride IV over 2 hours once daily from day 1
until hematologic
(ATO) complete remission or for a maximum of 60 days

POST TREATMENT PRESCRIPTIONS / MEDICATIONS:

□ Acyclovir 200 mg three times a day while neutrophils are < 1 x 109/L
□ Omeprazole 20 mg PO daily

SPECIAL PRECAUTIONS / MONITORING:

 Pregnancy Test before protocol initiation, as applicable.

 Ensure the serum potassium is kept above 4mmol/L and the serum magnesium above 0.7mmol/L
 ECG twice weekly, more frequently if clinically indicated.
 Patients do not need to receive antifungal prophylaxis unless there are other clinical factors.
 There is an interaction with azoles and amphotericin B with this regimen so ensure the benefits for
Antifungal therapy outweighs the risks.

ATRA + ATO Protocol – Version June 2022