Childhood Leukemia Overview

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Treating Leukemia in Children TOPICS

Treatment of children with acute promyelocytic leukemia (APL)

Treatment of acute promyelocytic leukemia (APL) differs from usual AML treatment. Most children respond well to this treatment, which is given in 3 phases:

  • Induction
  • Consolidation (also called intensification)
  • Maintenance


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

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 differentiation 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.

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 APL comes back after treatment, most often it 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 chemo may be another option. A stem cell transplant may be considered once a second remission is brought about.

Last Medical Review: 05/13/2015
Last Revised: 02/03/2016