Nonlymphocytic leukemia, acute (cont.)

The treatment of the subtype of AML called acute promyelocytic leukemia (APL) differs from that for other forms of AML. (APL is M3 in the FAB system.) Most APL patients are now treated first with all-trans-retinoic acid (ATRA) plus anthracycline type chemotherapy such as daunorubicin, idarubicin or mitoxantrone, or others which induce a complete response in 70% of cases and extend survival. APL patients are then given a course of consolidation therapy, which is likely to include cytosine arabinoside (Ara-C) and idarubicin. ATRA may be continued during consolidation and maintenance therapy in some patients. Arsenic trioxide may be used during 2nd remission induction if there has been a relapse. Bone marrow transplantation is considered during 2nd remission.

Bone marrow transplantation is used to replace the bone marrow with healthy bone marrow. First healthy marrow is then taken from another person (a donor) whose tissue is the same as or almost the same as the patient's. The donor may be a twin (the best match), a brother or sister, or a person who is otherwise related or not related. Then the patient (recipient) has their bone marrow destroyed by high dose chemotherapy with or without radiation. The healthy marrow from the donor is given to the patient through a needle in the vein, and the marrow replaces the marrow that was destroyed. A bone marrow transplant using marrow from a relative or from a person who is not related is called an allogeneic bone marrow transplant. A greater chance for recovery occurs if the doctor chooses a hospital that does more than five bone marrow transplantations per year.

The overall chance of recovery (the long-term prognosis) depends on the subtype of AML and the patient's age and general health.


Last Editorial Review: 9/20/2012

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