Vesanoid Indications/Uses

Tretinoin (Vesanoid) is indicated in combination with arsenic trioxide or chemotherapy for treatment of patients with acute promyelocytic leukaemia (APL) which is newly diagnosed, relapsed or refractory to chemotherapy (see Pharmacology: Pharmacodynamics under Actions and Dosage & Administration).
Treatment regimens: Combination of tretinoin with chemotherapy or arsenic trioxide is known to be effective and to induce very high rates of haematologic remission in patients with genetically confirmed APL, i.e. patients whose blasts harbour the t(15;17) by karyotyping or FISH or the PML-RARa fusion as detected by PCR. Thus, genetic confirmation of diagnosis is mandatory. Combination treatment with arsenic trioxide has been shown an effective treatment option in patients with newly diagnosed low-to-intermediate risk APL. However, because APL is characterised by high risk of early haemorrhagic death, current recommendations dictate that early treatment with tretinoin is started as soon as possible upon morphologic suspicion only.
For the selection of treatment strategy, the relapse risk indicated by pre-therapeutic white blood cell count (WBC) and platelet count (Sanz score) with high-risk (WBC >10 x 10⁹/L), intermediate risk (WBC ≤10 x 10⁹/L, platelet count ≤40 x 10⁹/L), and low risk (WBC ≤10 x 10⁹/L, platelet count >40 x 10⁹/L) should be taken into consideration.