What is not an acute bone abnormality

What is Acute Promyelocytic Leukemia (APL) - Cancer - 2021

What does it mean if you have acute promyelocytic leukemia (APL) and how is it treated?


Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML), a blood cancer. You can also hear it called the M3 AML. In North America, APL accounts for about 10% of all AML cases. In Italy and South America, APL can account for up to 65% of cases. It occurs equally in women and men, and the median age to start is 40 years.

While similar to the other subtypes in many ways, APL is distinctive and has a very specific treatment regimen. The treatment results for APL are very good and it is believed to be the most curable type of leukemia. Healing rates are up to 90%.

Genetics and Acute Promyelocytic Leukemia (APL)

The genetic abnormality or mutation most commonly seen in the DNA of leukemia cells is a translocation between chromosomes 15 and 17. This means that part of chromosome 15 breaks off and is exchanged for part of chromosome 17. This mutation results in the production of a protein that causes blood cell development to "stall" at the promyelocytic stage, when white blood cells are very young and immature.

What are promyelocytes?

Promyelocytes are cells that string together in the development of this type of white blood cell, with "babies" being myeloblasts or blasts and adults being myelocytes known as neutrophils, eosinophils, basophils, and monocytes. Promyelocytic leukemia cells can be compared to human adolescents. They look a bit like adults, but they can't get jobs paying bills, driving a car, or performing the daily functions of a fully mature person. Likewise, promyelocytic blood cells are too underdeveloped to take on the functions of fully mature white blood cells in the body.

Signs and symptoms

Patients with APL show many of the same symptoms as other types of acute myeloid leukemia (AML). Most signs of leukemia are the result of cancer cells crowding out the bone marrow and affecting the production of normal, healthy red blood cells, white blood cells, and platelets. These signs and symptoms are:

  • Have low energy or feel tired all the time
  • Shortness of breath during regular activities
  • Pale skin
  • Inexplicable fever
  • Increased healing time for cuts and bruises
  • Achy bones or joints
  • Difficulty fighting off infection

In addition to these signs of AML, APL patients also show other characteristic symptoms. They will often:

  • Have severe bleeding problems such as bruising, nosebleeds, blood in your urine or bowel movements. Girls and women with APL may have unusually heavy menstrual periods.
  • At the same time, abnormal, excessive blood clotting often occurs.

The symptoms of leukemia can be very vague and also indicate other non-cancerous conditions. If you are concerned about your health or the health of a loved one, it is always best to seek the advice of a doctor.


Treatment of acute promyelocytic leukemia (APL) is very different from other types of acute leukemia, so correct identification is critical.

Most APL patients are treated initially with all-trans retinoic acid (ATRA), a specialized form of vitamin A. ATRA therapy is unique in that it actually forces promyelocyte leukemia cells to mature. Kind of like graduation forcing teenagers into adult roles (at least sometimes) in our comparison. This phase of treatment is known as "induction".

While ATRA can bring an APL patient into remission by bringing all of the leukemia cells to maturity, it cannot cure the source of the leukemia. As a result, long-term results for treatment improve when doctors add standard chemotherapy. This face of treatment is known as "consolidation".

After chemotherapy, patients are often treated with ATRA, sometimes combined with other drugs, for at least a year. This final phase of treatment is known as "maintenance".

If leukemia does not respond or returns to ATRA and chemotherapy, APL can also be treated with arsenic trioxide (ATO).


Treatment of APL is successful in the vast majority of cases.

Coping and Support

While acute promyelocytic leukemia has an excellent prognosis, "getting up", at least for leukemia, can be difficult and draining. Reach out to family and friends. Don't worry about needing help and getting help at this stage of your life. You will be surprised how it not only helps you when others help but also brings them happiness. Read these tips on how to deal with leukemia and lymphoma.

Take the time to learn more about survival. When cancer treatment ends, many people feel depressed rather than happy. Persistent treatment side effects and time spent on the emotional roller coaster of cancer can make you wonder if you'll ever feel normal again. Ask for help and don't just accept your "new normal". There is much that can be done to help cancer survivors thrive. And don't forget that sometimes good things can come from cancer. Studies actually show us that cancer changes people in good ways, not just badly.