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Chemotherapy is the main treatment for most types of acute myeloid leukemia (AML). But acute promyelocytic leukemia (APL) is different from other types of AML in some important ways.

Researchers have found that the leukemia cells in APL have a specific gene change that makes them sensitive to certain drugs that aren’t like regular chemo drugs:

  • All-trans-retinoic acid (ATRA, tretinoin, or Vesanoid®)
  • Arsenic trioxide (ATO, Trisenox®)

These drugs are used for APL, but they are not helpful for any other type of AML. One or both of these drugs may be used as a part of the treatment of APL.

Side effects

These drugs can cause differentiation syndrome, most often during the first treatment cycle. Symptoms include breathing problems from fluid buildup in the lungs and around the heart, low blood pressure, kidney damage, and severe fluid buildup elsewhere in the body. It can often be treated by stopping the drugs for a while and giving a steroid.

ATRA can also have other side effects, such as:

  • Headache
  • Fever
  • Dry skin and mouth
  • Skin rash
  • Swollen feet
  • Sores in the mouth or throat
  • Irritated eyes
  • Higher blood lipid levels (like those of cholesterol and triglycerides)

These side effects often go away when the drug is stopped.

Most side effects of arsenic trioxide are mild and can include:

  • Tiredness
  • Nausea and vomiting
  • Diarrhea
  • Belly pain
  • Nerve damage leading to numbness and tingling in the hands and feet
  • Problems with heart rhythm. Your doctor may check your EKG often (even daily) while you are getting this drug.

More information about these drugs and the treatment of APL can be found in Leukemia–Acute Myeloid (Myelogenous).

Last Medical Review: 04/21/2015
Last Revised: 02/22/2016