acute promyelocytic leukemia | Treatment of acute promyelocytic leukemia

Treatment of acute promyelocytic leukemia





Acute promyelocytic leukemia (LPA) is a subtype of acute myeloid leukemia (LAM) that has its own treatment options.

Induction treatment
The purpose of the PCPA induction treatment is to treat all leukemic cells present in the blood and bone marrow and to generate remission.

Tretinoin (All-trans retinoic acid, ATRA, Vesanoid) is used to treat the PCPA. This medicine comes from vitamin A. It must be followed by the administration of other chemotherapeutic agents or associated with it to generate a long-term remission. From 80 to 90% of people with LPA will have a long-term remission.

A anthracycline, as one of the following, is associated with the Tretinoin:

Daunorubicin (Cerubidine, Daunomycin)
Idarubicin (Idamycin)
Tretinoin may be associated with arsenic trioxide, rather than a anthracycline, when the number of white blood cells is 10 000 or less during diagnosis.

Consolidation processing
Consolidation processing is also called post-remission processing. The purpose of the PCPA consolidation treatment is to treat all leukemic cells still present in the blood or bone marrow once the remission is reached. It is used to maintain a complete remission and prevent recurrence.

In the process of consolidating the PCPA, Tretinoin and idarubicin or daunorubicin continue to be administered. You can add other medications including:

Cytarabine (Cytosar)
Mercaptopurine (Purinethol, 6-MP)
Methotrexate
Arsenic trioxide
Maintenance treatment
The purpose of the maintenance treatment of the PCPA is to prevent leukemic cells from reappearing (recurrence).

Maintenance treatment includes the administration of Tretinoin for 1-2 years. It can be administered alone or associated with:

methotrexate;

to the mercaptopurine.

Treatment of recurrent or refractory PCPA

A recurrent LPA is a leukemia that reappeared after being treated and reached remission. A refractory PCPA is a leukemia that has not responded to treatment. The complete remission was not achieved because chemotherapy did not destroy enough leukemic cells.

The most used treatments for the LPA recurrent or refractory are among other things:

Tretinoin and a chemotherapeutic agent such as Cytarabine and daunorubicin

Arsenic trioxide

A allograft or a stem cell autograft (proposed for a recurrent LPA if a second remission has been achieved)

Support Treatment

Support treatment is important in each phase of the treatment of the PCPA. It is used to control the complications that usually occur because of the treatment of the PCPA and the disease itself.

Support treatments administered for a recurrent or refractory PCPA may include:

Antibiotics and antifungals to treat infections;

Growth factors to help bone marrow recover from chemotherapy (chemotherapy may affect the bone marrow by preventing it from producing enough healthy blood cells, which may increase the risk of infection);

Transfusion of red blood cells, platelets, fresh frozen plasma and cryoprecipitate (a product that replaces coagulation factors) if necessary.

Differentiation Syndrome Treatments

Differentiation syndrome was called retinoic acid syndrome. It is a complication of tretinoin, which can also occur with arsenic trioxide. It is most often observed in the first cycle of treatment based on these medications.

The symptoms of the differentiation syndrome are as follows:

Fever

Weight gain

Swelling caused by fluid accumulation in the body (edema)

Accumulation of fluid around the lungs (pleural effusion)

Accumulation of fluid around the heart (pericardial effusion)

Shortness

Difficulty breathing

Lower blood pressure

If the symptoms of differentiation syndrome are mild, it is usually possible to continue to take tretinoin or arsenic trioxide. Doctors also prescribe a steroid, such as dexamethasone (Decadron, Dexasone).

If the differentiation syndrome is severe, doctors will stop administering tretinoin or arsenic trioxide and instead give steroids until symptoms disappear. Once this is the case, you can start taking the medicine again, usually with dexamethasone.

Clinical trials

You may be asked if you would like to participate in a clinical trial on the PCPA. Learn more about clinical trials