Dr. Edward Allan Sison, a former St. Baldrick’s Fellow, is a faculty member at Baylor College of Medicine and Texas Children’s Cancer Center. He’s researching ways to make chemotherapy more effective in children with high-risk leukemias. He explains APL leukemia symptoms, treatment options, and how your support is moving research forward to help kids with this disease.
What is Acute Promyelocytic Leukemia (APL)?
Acute promyelocytic leukemia (APL) is a rare but aggressive blood cancer that targets white blood cells, specifically promyelocytes. These immature cells fail to mature into infection-fighting white blood cells and instead multiply quickly, crowding the blood and bone marrow with abnormal cells.
Signs and Symptoms of Acute Promyelocytic Leukemia
Spotting the signs of APL early is crucial for timely treatment. Common symptoms include:
- Fatigue or weakness
- Unexplained weight loss
- Bone pain or joint discomfort
- Fever or frequent infections
- Easy bruising or unusual bleeding
In some cases, APL affects the brain or spinal fluid, causing additional symptoms such as blurry vision, headaches, seizures, nausea, or facial drooping.
During a physical exam, doctors may also notice:
- Tiny red spots on the skin (petechiae)
- Abdominal tenderness
- Swelling of the liver or spleen
How Doctors Diagnose Acute Promyelocytic Leukemia
Doctors begin diagnosing APL with a complete blood count (CBC), which measures red blood cells, white blood cells, and platelets. Abnormal white blood cell counts often raise suspicion of leukemia.
If leukemia is suspected, doctors examine blood under a microscope to confirm the presence of APL cells. Additional findings may include low hemoglobin (anemia) or a low platelet count.
To confirm the diagnosis, doctors perform a bone marrow biopsy. By analyzing a sample of bone marrow, they can identify leukemia cells and determine the best course of treatment.
Treatment Options for APL
Treatments for APL have advanced significantly, offering patients better outcomes. Options include:
- Standard chemotherapy: A powerful method to eliminate leukemia cells.
- Targeted medications: Drugs like all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) destroy leukemia cells and help them mature into healthy white blood cells.
Until recently, children with APL received a combination of ATRA, ATO, and chemotherapy. However, new research shows that chemotherapy-free treatments might be equally effective.
How Research is Transforming APL Treatment
Groundbreaking clinical trials are revolutionizing APL treatment. One major study in adults compared two regimens: ATRA plus ATO versus ATRA combined with chemotherapy. The ATRA-ATO combination showed higher cure rates, better long-term survival, and fewer side effects than the chemotherapy-based approach.
Building on this success, the Children’s Oncology Group (COG) is now running a clinical trial for children with APL. This study aims to verify that the chemotherapy-free approach of ATRA and ATO can deliver high cure rates with fewer long-term side effects.
Why Early Detection of APL Matters
Acute promyelocytic leukemia is highly treatable, especially with early diagnosis. Advances in targeted therapies such as ATRA and ATO have dramatically increased survival rates for both children and adults.
If you or a loved one experiences symptoms like fatigue, bruising, or frequent infections, consult a doctor immediately for testing and diagnosis.
Raising awareness of APL symptoms, diagnosis, and treatment options ensures patients receive timely, effective care and achieve the best possible outcomes.
Has your child been touched by childhood cancer or do you know a child that has been diagnosed? St. Baldrick’s Honored Kids, who have been affected by cancer, inspire fundraising participants to be part of the Foundation’s mission — to fund lifesaving research.
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