Treatment of Acute Promyelocytic (M3) Leukemia

Early diagnosis and treatment of acute promyelocytic leukemia (APL), the M3 subtype of acute myeloid leukemia (AML), is important because patients with APL can develop serious blood-clotting or bleeding problems. This is less often a problem now that treatment includes differentiating drugs like all-trans-retinoic acid (ATRA). Other treatments might include chemotherapy and transfusions of platelets or other blood products.

Induction

The treatment of most cases of APL differs from usual AML treatment. Initial treatment includes the non-chemotherapy drug all-trans-retinoic acid (ATRA), which is most often combined with an anthracycline chemotherapy (chemo) drug (daunorubicin or idarubicin), sometimes also with the chemo drug cytarabine (ara-c).

Another option is to give ATRA plus another differentiating drug called arsenic trioxide (Trisenox). This is often used in patients who can’t tolerate an anthracycline drug, but it’s an option for other patients as well.

Consolidation

As with other subtypes of AML, patients with APL then receive post-remission treatment. What drugs are used depends on what was given for induction. Some of the options include:

  • An anthracycline along with ATRA for a few cycles (sometimes different anthracyclines are used in different cycles)
  • An anthracycline plus cytarabine for at least 2 cycles
  • Arsenic trioxide for 2 cycles (over about 2½ months), then ATRA plus an anthracycline for 2 cycles
  • ATRA plus arsenic trioxide for several cycles

Maintenance

For some patients, consolidation may be followed by maintenance therapy with ATRA for at least a year. Sometimes low doses of the chemo drugs 6-mercaptopurine (6-MP) and methotrexate are given as well.

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Last Medical Review: December 9, 2014 Last Revised: February 22, 2016

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