Treatment of acute promyelocytic leukemia (APL) differs from usual AML treatment. Most children respond well to this treatment.
Induction
Along with chemo, children with APL get a drug something like vitamin A called ATRA (all-trans retinoic acid). Although ATRA alone often brings about a remission, combining it with chemo gives better long-term results.
Spread to the brain or spinal cord is very rare with APL, so these areas most often do not need to be treated with chemo.
The side effects of ATRA treatment differ from those of standard AML chemo because of a possible problem called retinoic acid syndrome. It can lead to breathing problems due to fluid build-up in the lungs, low blood pressure, kidney damage, and severe fluid build-up elsewhere in the body. It can often be treated by stopping the ATRA for a while and giving a steroid.
During treatment, some patients with APL may also have blood-clotting problems. They may be given a "blood thinner" to help prevent or treat this.
Consolidation (Intensification)
This is usually much like induction, involving both ATRA and chemo. Because of the success of this treatment, stem cell transplant is not usually advised as long as the child stays in remission.
Maintenance
Children with APL may get maintenance therapy with ATRA, often with chemo, for about one year.
Relapsed APL
If the leukemia comes back after treatment, most patients can be put into a second remission. Arsenic trioxide is a drug that works very well in this setting, but it can sometimes cause problems with heart rhythms. Children getting this drug need to have their blood mineral levels watched closely. A stem cell transplant may be considered once a second remission is brought about.
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