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Acute Promyelocytic Leukemia (APL)

Leukemia is a type of cancer in white blood cells, which grow in bone marrow. Acute promyelocytic leukemia (APL) is a type of acute myeloid leukemia. It develops when promyelocytes, an immature type of white blood cell, grow abnormally and crowd out healthy blood cells.

APL occurs more often in adults and is usually diagnosed around age 40. It is highly curable in most patients:

  • The cure rate for children is 85 to 90 percent.
  • More than 90 percent of adult APL cases go into remission after initial treatment.
  • About 70 to 90 percent of adults with APL stay in long-term remission with continued treatment.

Acute promyelocytic leukemia: what you should know

Acute promyelocytic leukemia risk factors

  • Repeated exposure to benzene, a chemical found in cigarette smoke, gasoline and other petroleum products
  • Genetic disorders including Down syndrome and Shwachman-Diamond syndrome
  • Exposure to high levels of radiation

Acute promyelocytic leukemia symptoms

  • Easy bruising or bleeding
  • Higher risk of developing blood clots
  • Pinhead-sized red spots in the skin
  • Abnormal or excessive bleeding from the gums or nose, blood in the urine or menstrual bleeding
  • Fatigue or very pale skin
  • Aches in bones or joints
  • Loss of appetite or weight loss

How can I get help for acute promyelocytic leukemia?

If your physician suspects you have APL, you will need further testing to confirm the diagnosis. Such tests may include the following:

  • Blood tests to confirm the APL subtype of leukemia
  • Review of previous bone marrow studies to assess your chromosomes
  • Needle aspiration or biopsy (if necessary) for a new sample of bone marrow
  • Tests to evaluate how well your kidneys, liver and heart are functioning
  • Molecular test to detect certain markers in leukemia cells that can be targeted with specific drugs

Care for acute promyelocytic leukemia at Rush

It’s important to start treatment for acute promyelocytic leukemia quickly, because serious blood clotting and bleeding problems may develop. Treatment options differ from those for acute myeloid leukemia. There are three phases:

  • Induction: All-trans retinoic acid (ATRA) to help abnormal promyelocytes develop into healthy cells (neutrophils), in combination with either chemotherapy or arsenic trioxide (ATO)
  • Consolidation: ATRA in combination with either chemotherapy or ATO to ensure remission
  • Maintenance: ATRA combined with chemotherapy for long-term remission

These three phases of treatment are usually successful in curing APL. If the leukemia returns, physicians may repeat these treatments or combine them with stem cell transplantation. A transplant from a healthy donor will help new, healthy blood cells and platelets grow.

Why choose Rush for acute promyelocytic leukemia care?

  • Rush has an experienced, multidisciplinary team of specialists in cancer, blood, radiation therapy and stem cell transplants. The team focuses on individual care through weekly conferences to determine the best treatment for each new patient.
  • Patients of childbearing age have several fertility preservation options through the Rush Center for Advanced Reproductive Care, including cryopreservation of sperm and eggs.
  • Rush’s pediatric leukemia program has experienced specialists dedicated to caring for children with leukemia.

Departments and programs that treat this condition