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.

Induction

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 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 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, 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 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.