Full Answer
What are the phases of APL treatment?
APL treatment has three phases: induction, consolidation, and maintenance. There is debate among experts about the ideal induction therapy, the best initial treatment for the elderly, the subset of patients most likely to benefit from maintenance therapy, and the most effective regimen for relapsed disease.
What is the duration of treatment for acute myeloid leukemia (APL)?
A bone marrow biopsy is usually done about a month after starting treatment, to see if the leukemia is in remission. Induction is typically continued until the APL is in remission, which might take up to 2 months. Once APL is in remission, consolidation is needed to keep it in remission and try to get rid of the remaining leukemia cells.
What are the treatment options for APL that doesn't go away?
The most common options for maintenance therapy are ATRA alone, or ATRA along with chemo (6-mercaptopurine (6-MP) and/or methotrexate). Maintenance therapy is typically given for about a year. Treating APL that doesn't go away or comes back
How long does atra take to work in APL?
ATRA 45 mg/m2/day PO in 2 divided doses starting on Day 1 plus daunorubicin 50 mg/m2 IVP on days 3-6 plus cytarabine 200 mg/m2/day continuous IV infusion over 24 h on days 3-9; 1 cycles until complete remission or a maximum of 90 days. European APL regimen:
How many phases of APL treatment?
Treatment Phases. Treatment of APL is divided into three phases, each with its own objectives. Induction therapy starts immediately after diagnosis with the goals to kill as many APL cells as possible, bring blood cell counts to normal levels, and decrease APL-related symptoms.
What is the drug used for APL?
There are several types of anthracyclines; daunorubicin (Cerubidine®) and idarubicin (Idamycin®) are the drugs most commonly used in the treatment of APL, typically in combination with ATRA.
What is APL in medical terms?
Acute promyelocytic leukemia (APL) is a unique subtype of acute myeloid leukemia (AML). APL cells have a very specific abnormality that involves chromosomes 15 and 17, leading to the formation of an abnormal fusion gene called PML/RARα. This mutated gene causes many of the features of the disease. APL accounts for about 10-15 percent ...
What is the meaning of "promyelocytes" in APL?
Promyelocytes are immature white blood cells. In APL, these cells are overproduced and accumulate in the bone marrow. Signs, symptoms and complications of APL result from the overproduction of promyelocytes and the underproduction of healthy blood cells. Treatment for patients with acute promyelocytic leukemia ...
What is APL classification?
APL is classified into the two following categories of risk, based on the patient’s white blood cell count at diagnosis:
Is APL a cure for leukemia?
Because of advances in diagnosis and treatment of this disease, APL is now considered the most curable form of adult leukemia. Cure rates of 90 percent have been reported from centers specializing in APL treatment.
Can APL cause side effects?
APL treatment can cause unwanted and unpleasant side effects. Side effects may be caused by the drug type and dose used, length of treatment and the patient’s overall health. Management of side effects is important. If you have any concerns about your side effects, talk to your doctor to get help. Most side effects are temporary and resolve when treatment is completed. However, patients with APL may need specific kinds of supportive care. See Acute Promyelocytic Leukemia Facts to learn more.
What is the first phase of APL treatment?
Differentiating agents are part of the standard treatment for all people with APL. Here is an example of how these medicines may be used: Induction. This is the first phase of treatment. The goal is to try to lower the number of leukemia cells and put APL into remission.
What is APL in medical terms?
Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML). This subtype is treated with different medicines than other types of AML. This is because the leukemia cells in APL are often very sensitive to medicines called differentiating agents. APL is one of the most curable forms of leukemia.
How long do you take Atra for leukemia?
Sometimes the doses and timing are a little different. Maintenance. Some people continue to take ATRA for a year or 2 to keep any leukemia cells under control. This is often the plan for people with a high chance that the leukemia will come back.
Can ATO be used for leukemia?
Sometimes chemo medicines may be given, too. ATO can also be used if the leukemia comes back (relapses) after treatment with ATRA. Or it can be used for leukemia that doesn't go into remission by the end of consolidation.
What is APL in biology?
Acute promyelocytic leukemia (APL) is a distinct variant of acute myeloid leukemia (AML). It is classified as AML M3 by the old French-American-British (FAB) system and as APL with translocation between chromosomes 15 and 17—that is, t (15;17)—by the World Health Organization (WHO) classification system.
How long does ATRA therapy last?
Treatment with ATRA should be continued until terminal differentiation of blasts and achievement of complete remission. Therapy should not be modified on the basis of incomplete blast maturation (differentiation) detected up to 50 days or more after the start of treatment.
What causes early death in APL patients?
Intracerebral and pulmonary hemorrhages are the most frequent causes of early death in patients with APL, both before intiation of treatment and shortly afterward. Thrombotic complications occur less commonly. Consequently, measures to counteract coagulopathy, as follows, should be started immediately [ 1] :
What is consolidation therapy?
Consolidation therapy is based on the potential risk of relapse in patients who undergo induction therapy. Its main goal is to convert morphologic and cytogenetic remission into durable molecular remission. [ 9]
COMPANION ARTICLES
Treatment of Acute Promyelocytic Leukemia With No or Minimal Chemotherapy: Now a Reality in Common Clinical Practice. September 22, 2018
COMPANION ARTICLES
Treatment of Acute Promyelocytic Leukemia With No or Minimal Chemotherapy: Now a Reality in Common Clinical Practice. September 22, 2018
What are the phases of APL?
APL treatment has three phases: induction, consolidation, and maintenance. There is debate among experts about the ideal induction therapy, the best initial treatment for the elderly, the subset of patients most likely to benefit from maintenance therapy, and the most effective regimen for relapsed disease.
Where should acute leukemia be treated?
Answer. Patients with acute leukemia should be treated in centers staffed by specially trained physicians and nurses. Availability of supportive care, such as platelet transfusion therapy, and a well-equipped laboratory is also crucial. Given the frequent abrupt onset of acute promyelocytic leukemia (APL) and the risk of severe hemorrhagic events, ...
Can ATRA eradicate clone?
However, ATRA alone cannot eradicate the malignant clone. Achievement of complete hematologic and molecular remission requires the addition of ATO or chemotherapy. [ 21, 22] Resistance to ATRA has been seen with cytogenetic variants of APL, especially cases with the PLZF-RARA mutation.