Treatment for APML
Treatment for the subtype of AML known as acute promyelocytic leukaemia (APML) is different from most other AML treatment and is given in three phases.
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A drug called all-trans retinoic acid (ATRA), which is based on vitamin A, is the main type of induction treatment. It’s not a chemotherapy drug, but it may be given with chemotherapy. ATRA makes immature promyelocytes mature, so they are no longer leukaemia cells. It is taken as a tablet. People with APML are also treated with arsenic trioxide. This is given as a daily injection.
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 the levels of potassium and other electrolytes.
In most people with APML, treatment with ATRA and arsenic trioxide leads to a remission. Some people with high white cell counts may also need intravenous chemotherapy. Samples of your bone marrow may be tested for a genetic 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 (recurring).
Some people then have more chemotherapy as maintenance treatment for two years or more.
Common side effects of ATRA and arsenic trioxide include headaches and feeling sick (nausea). 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 Anoop Enjeti, Senior Staff Specialist Haematologist, Calvary Mater Newcastle, and Conjoint Senior Lecturer, The University of Newcastle; Ray Araullo, Deputy Head, Social Work Department, Royal North Shore Hospital; Shehaan Fernando, Consumer; Narelle Greentree, Clinical Nurse Specialist, Hunter Haematology Unit, Calvary Mater Newcastle; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Karen Maddock, Haematology Clinical Nurse Consultant, Westmead Hospital; Melanie Sexton, Consumer; Dr Jonathan Sillar, Haematology Registrar, Calvary Mater Newcastle, and Conjoint Fellow, The University of Newcastle.
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