Acute promyelocytic leukemia (APL) is a subtype of acute myelogenous leukemia (AML) that has its own treatment options.
The goal of induction treatment for APL is to treat all the leukemia cells in the blood and bone marrow and bring about a remission.
Tretinoin (all-trans retinoic acid, ATRA, Vesanoid) is used to treat APL. It is a drug derived from vitamin A. It must be followed by or given with other chemotherapy drugs to bring about a long-lasting remission. About 80%–90% of people with APL reach a long-lasting remission.
An anthracycline drug, such as one of the following, is given in combination with tretinoin:
Tretinoin may be given in combination with arsenic trioxide, rather than with an anthracycline drug, when the white blood cell count at diagnosis is 10,000 or less.
Consolidation treatment is also called post-remission therapy. The goal of consolidation treatment for APL is to treat any leukemia cells that are still in the blood or bone marrow once remission is reached. It is done to maintain complete remission and prevent relapse.
During consolidation treatment for APL, tretinoin is continued along with idarubicin or daunorubicin. Other drugs that may be added include:
The goal of maintenance treatment for APL is to prevent leukemia cells from coming back (called relapse).
Maintenance treatment includes continuing tretinoin for 1–2 years. Tretinoin may be used alone or in combination with:
Relapsed, or recurrent, APL means the leukemia has come back after treatment and reaching remission. Refractory APL means the leukemia did not respond to treatment. Complete remission has not been reached because the chemotherapy did not kill enough leukemia cells.
The most common treatment for relapsed or refractory APL includes:
Supportive therapy is important during every phase of APL treatment. It is used to treat the complications that usually happen with treatments for APL and the disease itself.
Supportive therapies given during treatment for relapsed or refractory APL may include:
Differentiation syndrome used to be called retinoic acid syndrome. It is a complication caused by tretinoin, and it may also happen with arsenic trioxide. It is most often seen during the first cycle of treatment with these drugs.
The symptoms of differentiation syndrome include:
If the symptoms of differentiation syndrome are mild, you can usually keep taking tretinoin or arsenic trioxide. Doctors will also prescribe a steroid, such as dexamethasone (Decadron, Dexasone).
If differentiation syndrome is severe, doctors will stop giving tretinoin or arsenic trioxide and give steroids until the symptoms completely go away. Once the symptoms go away, you can start taking the drug again, usually along with dexamethasone.
You may be asked if you want to join a clinical trial for APL. Find out more about clinical trials.
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