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Overview of APL
- White blood cells are made in the bone marrow. Stem cells reside in this marrow and make every type of blood cell that we need1
- Stem cells constantly produce new blood cells to replace damaged or old ones. New cells leave the bone marrow only once they’ve fully matured1
- When someone has leukemia, this control of blood cell production breaks down, and the stem cells make very large numbers of immature blood cells. In APL these are abnormal, or cancerous, myeloid cells. These never mature into proper white blood cells, vital to a healthy immune system, and so people with APL have an increased risk of infection1
- The cancer cells cluster in the bone marrow and prevent other important blood cells from being made. Most of the problems of leukemia are caused by the lack of normal cells in the blood, rather than the leukemia cells themselves1
APL doesn’t have specific symptoms, so for this reason it can be confused with other common illnesses. APL usually develops quite quickly and certain symptoms develop over days or weeks. Common symptoms can be:1
- Unusual bruising and bleeding
- Breathlessness and tiredness
- Frequent and persistent infections
There are some less common symptoms: 1
- Bone pain from a build up of cancer cells in the bone marrow
- Swollen glands from a build up of cancer cells in the lymph nodes
- Abdominal pain from a swollen spleen or liver
Some people with APL may also develop small lumps on their skin, called chloromas, but this is very uncommon. A small amount of people experience symptoms like dizziness and bad circulation. People with APL may experience all, several, or only some of these symptoms.
APL comprises approximately 5-20% of all patients with newly diagnosed acute myeloid leukemia (AML). There are about 600-800 new case each year in the United States. In Canada, the age adjusted incidence of APL is 0.073 cases per 100,000. The rate increases to a constant level among young adults after the age of 10 and declines after the age 60. The mean age is between 40 and 50 years old, and both women and men are almost equally affected.1-4
Relapse occurs in 10-15% of patients with APL and in 20-30% in patients with high-risk APL (blood cell count above 10,000 + platelet count less than 40,000).4
Seeking diagnosis and care
Different leukemias are classified according to the type of white blood cell affected and the speed with which the cancer progresses. APL is aggressive and progresses quickly.1
Patients must start treatment quickly after being diagnosed. Treatment options include chemotherapy and drugs. Patients with relapsed or refractory APL can also use chemotherapy as well as non-chemo drugs, and may be offered a stem cell transplant or will be put into a clinical trial.1
Supportive care is a large part of treatment for all APL patients. Supportive care helps with the prevention and relief of infections, as well as disease and treatment complications.1
- Leukemia & lymphoma research. Acute promyelocytic leukemia. https://leukaemialymphomaresearch.org.uk/information/leukaemia/acute-promyelocytic-leukaemia-apl/tests Accessed 09/07/2013.
- Onkopedia Guidelines. Acute promyelocytic leukemia. www.onkopedia-guidelines.info/en/onkopedia/guidelines/acute-promyelocytic-leukemia-apl Accessed 25/10/2013.
- Perspectives in oncology. New evidence. Advances in the management of acute promyelocytic leukemia: summary of the presentation by Dr. Lo-Coco at AMHOQ. http://www.newevidence.com/oncology/advances-in-the-management-of-acute-promyelocytic-leukemia-summary-of-the-presentation-by-dr-lo-coco-at-amhoq/ Accessed 15/09/2015.
- UpToDate. Treatment of relapsed or refractory acute promyelocytic leukemia in adults. www.uptodate.com/contents/treatment-of-relapsed-or-refractory-acute-promyelocytic-leukemia-in-adults Accessed 29/11/2013.
Canadian Cancer Society. Treatment of acute promyelocytic leukemia.
Leukemia & Lymphoma Society of Canada
American Cancer Society. Treatment of acute promyelocytic leukemia.
National Cancer Institute