Childhood Leukemia Overview

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Treating Leukemia in Children TOPICS

Treatment of children with acute promyelocytic leukemia

Treatment of acute promyelocytic leukemia (APL) differs from usual AML treatment. Most children respond well to this treatment.


Many children with APL may have blood-clotting problems, which can be serious. They may be given a “blood thinner” to help prevent or treat this.

Along with chemotherapy (chemo), children with APL get a drug related to vitamin A called ATRA (all-trans retinoic acid).

ATRA can cause a problem called retinoic acid syndrome. It can include 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.

APL rarely spreads to the brain or spinal cord, so these areas most often do not need to be treated with chemo.

Consolidation (Intensification)

This is usually much like induction, using 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.


Children with APL may get maintenance therapy with ATRA, often with chemo, for about a year.

Relapsed APL

If the leukemia comes back after treatment, most children 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. ATRA plus chemotherapy may be another option. A stem cell transplant may be considered once a second remission is brought about.

If you’d like information on a drug used in your child’s treatment, see our Guide to Cancer Drugs, or call us with the names of the medicines your child is taking.

Last Medical Review: 11/11/2013
Last Revised: 02/03/2014