Acute Promyelocytic Leukemia

Overview

Acute promyelocytic leukemia (say: pro-mye-lo-SIT-ik loo-KEE-mee-ah) is a rare type of blood cancer. It starts in the bone marrow, the spongy tissue inside your bones where blood cells are made. In APL, a genetic change stops young white blood cells from growing up properly. These abnormal cells build up and fill the bone marrow, crowding out healthy cells. APL is a medical emergency because it can also cause severe bleeding.

No, APL is rare. It accounts for about 5 to 10 out of every 100 cases of acute myeloid leukemia in adults.

APL can happen at any age, but it is most common in adults around 40 to 50 years old. It affects men and women about equally, and it is rare in children.

Symptoms

Common symptoms

• Unexplained bruising or tiny red or purple spots on the skin (called petechiae)
• Frequent nosebleeds or bleeding gums
• Feeling very tired, weak, or short of breath
• Fever or frequent infections
• Pale skin
• Bone or joint pain
• Heavier than normal periods in women

Symptoms in children

• Children with APL may show the same signs as adults, including easy bruising, nosebleeds, fatigue, and fever.
• They may also seem unusually pale or irritable and have less energy than normal.

Symptoms in older adults

• Older adults may experience confusion, dizziness, or extreme weakness.
• They might also have unusual bleeding, such as blood in the stomach or urine, which can be harder to notice.

Causes

Main causes

• The exact cause is not fully known.
• Most cases happen when a piece of chromosome 15 and a piece of chromosome 17 swap places. This is called a translocation.
• This gene change makes the body produce an abnormal protein that prevents white blood cells from maturing properly.

Risk factors

• Exposure to high levels of radiation or certain chemicals (like benzene) may increase the risk, but this is rare.
• APL is generally not inherited from parents and is not caused by anything a person did or did not do.

When to see a doctor

See a doctor urgently if:

• If you have unusual bleeding, easy bruising, or tiny red spots, especially if these symptoms appear suddenly, see a doctor the same day.

Book a routine appointment if:

• If you have been feeling unusually tired, have had fevers, or have noticed changes in your energy for more than a few weeks, make an appointment with your GP.

Diagnosis

A diagnosis is usually made with blood tests first. If those tests point to APL, the doctor will recommend a bone marrow test. In APL, the specific chromosome change is found in the blood or bone marrow cells. Because APL is an emergency, treatment often begins while the final tests are being confirmed.

Tests that may be done

• Complete blood count (CBC) to measure red cells, white cells, and platelets
• Blood smear to look at the cells under a microscope
• Clotting tests (coagulation panel) to check bleeding risk
• Bone marrow biopsy, where a small sample of bone marrow is taken from the hip bone
• Genetic or cytogenetic tests to look for the chromosome change

What to expect at your appointment

You will see a haematologist, a doctor who specialises in blood diseases. They will explain your test results and discuss a treatment plan. You may be admitted to the hospital right away. It is normal to feel scared, but your care team will support you every step of the way.

Treatment

APL is treated urgently in the hospital. The main goals are to stop or prevent bleeding, clear the abnormal cells from the bone marrow, and help healthy blood cells grow back. Modern treatment is very effective, and most people with APL can be cured.

Self-care at home

• Follow your healthcare team's advice about rest, activity, and safety while in the hospital.
• Use a soft toothbrush and avoid flossing if your gums bleed easily.
• Keep all follow-up appointments and tell your doctor about any new symptoms.
• Ask for help from family or friends when you need it.

Medical treatments

Treatment usually starts right away and may include targeted therapy medicines, which attack the specific abnormal protein caused by the gene change. These are often combined with chemotherapy. You may also receive platelet transfusions or clotting factors to reduce bleeding risk. After the leukemia is under control, you may continue with more treatment to keep it from coming back. In rare cases, a stem cell transplant may be offered if the disease returns, but this is not common for a first diagnosis.

When is surgery considered?

Surgery is not used to treat APL. The main treatments are medicines and supportive care.

Living with this condition

During treatment, you will likely spend several weeks in the hospital. After going home, you will need regular follow-up visits and blood tests. Your energy may be low, so plan rest periods and let your body recover gradually. Ask loved ones for help with daily tasks.

Lifestyle tips

• Avoid contact sports or activities that could cause bruising or injury.
• Use an electric razor instead of a blade razor to avoid cuts.
• Tell your dentist about your medical history before any dental work.
• Wash your hands often and avoid crowded places while your immune system is weak.

Diet and exercise

Eat a balanced diet with plenty of fruit, vegetables, and protein to support your recovery. Gentle activity, like short walks, can help improve energy – but always check with your doctor first. While recovering, avoid raw or undercooked foods if your immunity is low.

Mental health and emotional wellbeing

A cancer diagnosis can be overwhelming. You may feel anxious, sad, or frightened. These feelings are normal. Talking with your care team, a counsellor, or a close friend can help. If you feel very depressed or hopeless, please speak to your doctor – your mental health is just as important as your physical health.

Prevention

There is no known way to prevent APL, because it is caused by a random genetic change that is not linked to lifestyle or things you do.

Vaccines

There is no vaccine to prevent APL. However, your doctor may recommend certain vaccines (like flu or pneumonia vaccines) to protect you during and after treatment. Always discuss vaccines with your healthcare team.

Screening programmes

There is no routine screening test for APL in the general population. Detection happens when symptoms lead to blood tests.

Complications

If left untreated

• Severe internal bleeding, including bleeding in the brain, which can be life-threatening
• Blood clots (thrombosis) in veins or arteries
• Severe anaemia and increased risk of infections
• Leukemia spreading to other parts of the body

Long-term outlook

With modern treatment, the outlook for APL is very good. Most people are cured, especially if treatment begins quickly. More than 90% of people who receive prompt treatment achieve remission – meaning no signs of leukemia. Recovery can take several months, but many people go on to live full, healthy lives. Hope and early action are key.

Find support

International organisations

• Leukemia & Lymphoma Society (LLS) ↗
• Cancer Research UK ↗

Local organisations

• Macmillan Cancer Support ↗ · UK

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