Acute promyelocytic leukaemia (APL) treatment

The treatment you have will also depend on how high your blood count is when you are diagnosed.

Most people with APL (around 95%) have the PML/RARA gene. If you have this gene, then it’s more likely the common treatments described here will get rid of the leukaemia.

If you have a very rare type of APL, where the PML/RARA gene isn’t present, then standard treatments might not be as effective. Your treatment may involve trans retinoic acid (ATRA) with chemotherapy or one of the drug combinations used to treat acute myeloid leukaemia (AML), which can also work for APL.

If you have a lower white blood cell count when you're diagnosed, you’ll usually be treated with two drugs that work together: ‘arsenic trioxide’ and ‘all-trans retinoic acid’ (ATRA).

You will take ATRA as a capsule that you swallow. It works by stopping your white blood cells from getting “stuck” as immature promyelocytes (leukaemia cells), by helping them mature into healthy white blood cells.

Arsenic trioxide works in a similar way, but you will have this through a drip (intravenously).

If your doctor recommends this treatment option, you’ll start taking ATRA capsules straight away. Once your doctors have the results of tests that confirm you have APL, you’ll then start having your arsenic trioxide treatment.

You’ll receive arsenic trioxide in combination with ATRA as remission induction therapy for two months.

You will then have the same treatment as consolidation therapy, which means you will have it every two months with short breaks in between, for eight months.

You may have heard that arsenic is poisonous and be worried. Arsenic is only poisonous when used in high doses. Smaller doses of arsenic are safe when used in medicine. Arsenic trioxide is a very effective treatment for APL.

If you have a higher white blood cell count when you're diagnosed, you'll usually be given ATRA with chemotherapy to kill the leukaemia cells.

The group of chemotherapy drugs used to treat APL are called ‘anthracyclines’. You will have these through a drip (intravenously), usually into a vein in your arm.

If you’re treated with a combination of ATRA and anthracyclines, you will have:

• one cycle of induction treatment
• a further three cycles of consolidation treatment.

Each cycle of treatment will last a few days, and you’ll usually have a four-week recovery period before moving on to the next cycle.

You may start taking anthracyclines at the same time as ATRA or you may start a few days afterwards.