Acute promyelocytic leukemia (APL) is a type of cancer that affects the blood and bone marrow, causing severe bleeding disorders. A special form of “differentiation therapy,” called all-trans-retinoic acid (ATRA) therapy, is used to treat APL, followed by chemotherapy to completely cure the disease in over 75% of patients.
Acute promyelocytic leukemia (APL), or acute myeloid leukemia subtype M3, is a type of cancer that affects the blood and bone marrow. This condition, characterized by severe bleeding disorders, results from the accumulation of immature white blood cells called “promyelocytes” in the blood and bone marrow. Promyelocytes replace normal blood cells and platelets and cause a drop in normal blood cell counts.
Bleeding associated with APL can manifest as bruising on the body, a pinhead-sized rash under the skin, nose bleeds, bleeding in the mouth, and blood in the urine. Affected women may also experience excessive blood flow as part of menstrual bleeding. Fever, fatigue, increased susceptibility to infections, and bone and joint pain are some of the other major symptoms of APL.
The increased susceptibility to fever and infections is determined by the lowering of the body’s defenses due to the reduction of mature white blood cells. Likewise, the constant bleeding and rapid decline in red blood cells and platelets leads to anemia and fatigue. The bleeding symptoms of acute promyelocytic leukemia are sometimes found associated with disseminated intravascular coagulation (DIC), in which bleeding occurs from the skin, respiratory and digestive tracts, and even surgical wounds on the body.
An acute promyelocytic leukemia prognosis is made based on several factors, including a white blood cell (WBC) count. APL is a subtype of acute myeloid leukemia (AML), classified into seven major subtypes, M1 to M7, depending on the myeloid cell type that is abnormal. Of these seven subtypes, patients with M3 or acute promyelocytic leukemia have the best chance of survival and best outcomes. APL is most commonly seen in middle-aged people and young children of Latin American or Mediterranean descent.
The treatment method for APL is different from that of other subtypes of leukemia. A special form of “differentiation therapy,” called all-trans-retinoic acid (ATRA) therapy, is used to treat acute promyelocytic leukemia. ATRA induces immature promyelocytes to mature and thus prevents their proliferation. ATRA followed by chemotherapy was found to completely cure APL in over 75% of patients. Some patients may experience a relapse of APL; however, maintenance treatment with ATRA, low-dose chemotherapy, and arsenic trioxide has been found to reduce recurrence of this disease.
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