Evolution of Treatment for a Rare Type of Leukemia

Medical Author: Michael Lill, MD
Medical Editor: Leslie J. Schoenfield, MD, PhD
Medical Revising Editor: Melissa Conrad Stöppler, MD

One of my more vivid memories from the early days of my training in hematology (blood diseases) in Perth, Australia is of the tragedy of a young girl with acute promyelocytic leukemia (APL). This disease is a very serious, rare type of acute leukemia (cancer of the white blood cells). I admitted her to our oncology (cancer) floor in the hospital. A teenager, she had been completely well until one Sunday when she developed unusually heavy menstrual bleeding. She saw her doctor in her small country town on Monday, had a blood count done on Tuesday, and was flown up to us in Perth on Wednesday with a diagnosis of acute (rapid onset) leukemia. The next day, we performed a biopsy (removal of a tissue sample) of the bone marrow (where blood cells are made) that enabled us to confirm the diagnosis. We immediately started chemotherapy (medications that kill cancer cells) but that night she bled into her brain. Despite intensive medical efforts, including brain surgery, she died the next morning.

What a rapid course and horrible outcome! You can see why this patient has remained vivid in my memory for the past 15 years. Acute promyelocytic leukemia has always been one of the most feared of the acute leukemias. The reason for the fear is that a similar type of bleeding death often occurred during the initial (induction) chemotherapy of this leukemia. Remarkably, however, if these patients survived their induction therapy, many of them were cured by the chemotherapy.