To summarize the experiences in using all-trans retinoic acid (ATRA) for the differentiation therapy for acute promyelocytic leukemia (APL) since our introduction of its use in clinic in 1986.

Data resources came from Chinese Journal of Hematology, English-language literature using MEDLINE (1988 - 1998), book entitled "Treatment of Malignancies by Inducing Differentiation and Apoptosis" published by Shanghai Publishing House on Sciences and Technology, and our recent data to be published.

Thirty-five articles related to the purpose of this review were reviewed.

Data were checked for their quality, reliance and originality.

ATRA combined with chemotherapy can decrease the incidence of retinoic acid syndrome and produce a very high remission rate (90% - 95%) . Post-remission treatment should include chemotherapy and ATRA, the 5-year survival probability was able to attain 0.71 ± 0.06. The main problem in the treatment is early tolerance to ATRA and relapse of the disease. The most effective treatments for relapsed APL is to use arsenic trioxide.

The combination of ATRA, chemotherapy and arsenic oxide in the treatment of APL for elevating the remission rate and prolonging survival time deserves further study. Chin Med J 1999; 112(11):963-967