Arsenic trioxide in combination with all-trans retinoic acid can be made available within NHS Wales for the first line treatment of high-risk acute promyelocytic leukaemia, characterised by the presence of the t(15;17) translocation and/or the presence of the Pro-Myelocytic Leukaemia/Retinoic-Acid-Receptor-alpha gene, in adult patients unsuitable for anthracycline-based therapy.

The risks and benefits of the off-label use of arsenic trioxide for this indication should be clearly stated and discussed with the patient to allow informed consent.

In November 2016 OWMAG recommended this treatment in NHS Wales, in September 2023 there was a review of the recommendation. OWMAG found nothing new that affects the original decision.

Next review: this decision will be reviewed again after three years or earlier if new evidence becomes available.