Acute promyelocytic leukaemia treatment
How is APML treated?
The treatment for APML differs from the treatment of other types of acute leukaemia because it involves the use of a drug called all-trans retinoic acid (ATRA). ATRA is not a chemotherapy drug; it is actually a derivative of vitamin A, which works by making the immature promyelocytes (the identifiable leukaemic cells in APML) mature properly. This drug is now used in combination with standard chemotherapy to induce a remission, and has improved survival rates for people diagnosed with APML.
Chemotherapy agents and a medication called Arsenic Trioxide (ATO) are also used in the treatment of APML. The first cycle of treatment a patient receives is called induction therapy. In most cases you will need to be admitted to hospital for induction chemotherapy.
At the time of diagnosis of APML a patient is at high risk of side effects resulting from clotting and bleeding problems. In general, these risks are greatest during the first two to four weeks, and increase the need to commence treatment urgently if a diagnosis of APML is suspected. Patients with APML have an increased risk of developing Disseminated Intravascular Coagulation. This is a serious condition in which clots form in blood vessels, causing a decrease in the production of clotting factors and thereby increasing the risk of bleeding. Blood tests monitoring clotting factors and platelet counts will be conducted frequently to ensure intervention can be undertaken if bleeding problems arise.
Further cycles of chemotherapy will be given after the initial induction treatment. This is called consolidation therapy and can last for up to two years, and is an important part of minimising the chances of the APML returning (relapse). Although not routinely used, stem cell transplants may sometimes be considered for patients who have relapsed after initial induction therapy.
Generally speaking the prognosis for APML is better than other types of acute leukaemia, however individual general health and history plays a role. Your specialist will discuss all treatment options and their side effects and benefits with you prior to commencing treatment.
Please note that the treatments described above are for patients who have the PML-RARA fusion gene present in their APML. Treatments for the less common subtype differ significantly.
Side effects of treatment
All treatments can cause side effects. However, the type and severity will vary between individuals, depending on the type of treatment used and how an individual responds to it. In general, more intensive treatment is associated with more severe side effects. It is important to report any symptoms you are having to your doctor or nurse. In most cases they can be treated and are reversible.
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