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Compound Realgar-Indigo Naturalis Formula + retinoic acid is a combination therapy used primarily for the treatment of acute promyelocytic leukemia (APL). The regimen consists of an oral traditional Chinese medicine-based formulation known as Realgar-Indigo naturalis formula (RIF) and all-trans retinoic acid (ATRA). RIF contains realgar (tetraarsenic tetrasulfide), Indigo naturalis, Salvia miltiorrhiza, and Pseudostellaria heterophylla. Its main active ingredients are tetraarsenic tetrasulfide (from realgar), indirubin (from indigo), and tanshinone IIA (from Salvia miltiorrhiza). The mechanism involves degradation of the PML-RARα oncoprotein—a fusion protein specific to APL—by promoting its ubiquitination and subsequent proteasomal degradation. This leads to differentiation of leukemic cells and cell cycle arrest. All-trans retinoic acid further induces differentiation of promyelocytes by activating the retinoic acid receptor alpha pathway. The combination has demonstrated efficacy comparable to arsenic trioxide plus ATRA in clinical trials in China for both adult and pediatric patients with newly diagnosed or relapsed APL[2][6][8].
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