About APML

Acute Promyelocytic Mylogenous Leukemia, or APML (others call it APL), is a fairly rare type of leukemia. The Stanford Hospital and Clinics providers who treated me tell me they see about 10 cases a year. And they’re a major referral center for Northern California and the rest of the US.

APML, in layman’s terms, is a disease of the bone marrow. For some reason the marrow starts producing immature cells in very large numbers. The blood cells control various functions — red blood cells carry oxygen, white blood cells fight infections, and platelets control clotting and stop bleeding. Since the cells are immature and numerous, they don’t serve their normal functions.

So, someone with APML gets short of breath and becomes pale (lack of oxygen carrying red blood cells), gets infections (lack of white blood cells), and has bleeding and bruising (lack of platelets). I first noticed bruises and shortness of breath. I really knew something was wrong when I found blood clots in my teeth — my gums were bleeding. I didn’t notice any infections, but I likely would if I had ignored the signs. (Look at the posts in the categories in the sidebar for more about my symptoms and diagnosis.) Without treatment, a person dies from internal bleeding and/or systemic infections.

APML had historically been quite fatal, with a very poor prognosis. In the early 1990s providers in Singapore where patients were allowed eastern herbal remedies in western style hospitals noticed that something was causing this usually fatal subtype to go into full remission. It was isolated, and was found to be a derivative of vitamin A. Further testing discovered a treatment for APML, all-trans retinoic acid (ATRA). After more clinical trials and fast-track approval by the FDA, ATRA was brought to the market by Roche (thank you, Roche!) in 1995.

The treatment of choice, which I underwent, was an initial round of chemotherapy, called induction, and treatment with ATRA, which is in pill form. Then another few rounds of lesser chemotherapy are provided in the next round of chemotherapy, called consolidation, still with ATRA. At that time the bone marrow should have been destroyed (the goal of chemotherapy) and replaced with healthy normal bone marrow (assisted by ATRA).

This treatment took what was almost a completely fatal disease to one that 80% of patients go into full remission, with a healthy five-year survival rate. That’s what I was told at the time of my diagnosis. Most of those that don’t make it have a reaction to ATRA. Further research uses, of all things, a form of arsenic as a secondary treatment if remission isn’t successful, with some clinical trials now using a combination of arsenic and ATRA in induction. Currently the five-year survival rate for APML is considered to be almost 100%.

The moral of the story — research into treatments for blood-related cancers do save lives. They saved my life.

Unfortunately, many other kinds of blood-related cancers, including closely related subtypes of acute myelogenous leukemia, still have a very poor prognosis. Support for the research funded by the Leukemia & Lymphoma Society can help save other lives.