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In recent years, the targeted therapy combining arsenic with all-trans retinoic acid (ATRA) has dramatically improved outcomes in pediatric acute promyelocytic leukemia (APL) [1, 2]. However, 5–10% of patients still experience relapse [3], which remains a major barrier to cure. Within this modern therapeutic framework, the risk factors for relapse in pediatric APL—particularly the role of arsenic pharmacokinetics—are not fully defined.
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