Treatment for the subtype of acute myeloid leukaemia (AML) known as acute promyelocytic leukaemia (APML) is different from most other AML treatments.
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Phases of treatment for APML
Induction phase
A drug called all-trans retinoic acid (ATRA) is the main type of induction treatment. It’s 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. People with APML are also treated with arsenic trioxide. This is given daily, through a drip into a vein.
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 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.
Consolidation phase
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).
Side effects of treatment for APML
Common side effects of ATRA and arsenic trioxide include headaches, bleeding and clotting problems, and feeling sick (nausea). 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.
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More resources
A/Prof John Moore (Conjoint UNSW), Senior Staff Specialist Haematology, Department of Haematology and Bone Marrow Transplant, Kinghorn Cancer Centre, St Vincent’s Hospital; Glynda Blomson, Consumer; Kevin Bloom, Senior Social Worker, Haematology and Bone Marrow Transplant, Royal North Shore Hospital; Sharon Frazer, Consumer; 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; Karen Maddock, Clinical Nurse Consultant – Haematology, Westmead Hospital.
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