Treatment for APML
Treatment for the subtype of AML known as acute promyelocytic leukaemia (APML) is different from most other AML treatments.
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A drug called all-trans retinoic acid (ATRA) is the main type of induction treatment. ATRA is not a chemotherapy drug, but it may be given with chemotherapy.
ATRA makes immature promyelocyte cells mature, so they are no longer leukaemia cells. It is taken as a tablet (orally).
People with APML are also treated with arsenic trioxide. This is given daily, through a drip into a vein or through a central venous access device (CVAD).
Induction with ATRA and arsenic trioxide is usually given over 5–6 weeks. You will have regular echocardiography (ECG tracing of the heart) and blood tests to monitor your full blood count and the levels of minerals in the blood.
In most people with APML, treatment with ATRA and arsenic trioxide leads to remission. Some people with high white cell counts may also need intravenous chemotherapy. Samples of your bone marrow will be tested for a gene change known as PML-RARA. This can help doctors work out whether you are in remission.
Further cycles of chemotherapy will be started 1–2 weeks after the induction phase ends. This phase, known as consolidation, may last for several months. It aims to destroy any cells that may have survived the induction phase and to stop APML returning (relapsing).
Side effects of ATRA and arsenic trioxide may include headaches, bleeding and clotting problems, and nausea (feeling sick). During the induction phase, an uncommon but serious reaction known as APML differentiation syndrome can cause breathing difficulties, fever, weight gain and high blood pressure. Tell your treatment team if you experience any of these side effects.
Dr Jonathan Sillar, Haematologist, Calvary Mater Newcastle Hospital; Dr Scott Dunkley, Haematologist, Royal Prince Alfred Hospital and Chris O’Brien Lifehouse; Sharon Frazer, Consumer; Dr Robin Gasiorowski, Staff Specialist, Haematology, Concord Hospital; Prof Angela Hong, Radiation Oncologist, Chris O’Brien Lifehouse, and Clinical Professor, The University of Sydney; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Heather Mackay, Clinical Nurse Consultant – Haematology, Westmead Hospital; Katelin Mayer, Clinical Nurse Consultant, Cancer Outreach Team, Nelune Comprehensive Cancer Centre.
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