Acute Promyelocytic Leukemia (APL) is a type of cancer that affects WBC or white blood cells and is a kind of acute myeloid leukemia (AML). As per the medical research, in APL cells, there is a rare alteration in the 15 and 17 chromosomes, by merging together and forming a unique gene called the PML/RARα gene. A number of the condition’s traits are brought on by this faulty gene. It can be said that ten to fifteen percent of the adult AML cases that are discovered annually are of APL.

 

The young white blood cells (WBC)are known as promyelocytes. Due to APL, these cells proliferate and gather in the bone marrow. Promyelocyte overproduction and healthy blood cell underproduction are the fundamental causes of the symptoms, indicators, and issues linked to APL.

 

Compared to the other subtypes of AML, Acute Promyelocytic Leukemia (APL) does not need to be handled in the same way. Currently, APL is regarded as one of the most treatable forms of adult leukemia due to improvements in diagnosis and treatment. The source suggests that up to 90% of patients who received treatment in clinics dealing with APL have been cured.

 

 

Signs and Symptoms of Acute Promyelocytic Leukemia

 

What are symptoms of Acute Promyelocytic Leukemia?

 

Acute Promyelocytic Leukemia (APL) is a type of anemia caused by the lack of red blood cells, white blood cells or platelets in the marrow. Among the severe symptoms of pancytopenia, it is possible to distinguish anemia, hemorrhaging, and infections.

 

Other APL symptoms are:

 

• You may find yourself losing some weight because your metabolism is up and you are using food for fuel.

 

• Since your white blood cell count is low, you are at a higher risk of getting sick or experiencing some form of infection.

 

• Reduction in the levels of haemoglobin or red blood cells leads to anaemia, a condition that may lead to fatigue.

 

 

Bleeding

 

Acute Promyelocytic Leukemia in an individual is caused by deficiency of platelets or blood clotting agents. Platelets reduce bleeding or perhaps stop it entirely. Blood clot formation is influenced by blood clotting factors. The following are signs of APL bleeding:

 

• Bleeding from the gums, nosebleeds, heavy menstrual flows, or any other source.

 

• Bruises are brought on by an intradermal blood clot.

 

• Headaches, eyesight issues, and trouble moving your arms and legs are some of the signs of a brain hemorrhage.

 

• Feces that are dark in color or have red blood striations in them.

 

 

So, it can be said that you may be suffering from APL if you have gastrointestinal bleeding.

 

 

Causes of APL

 

PML-RARa is the result of the mixture of two genes involved in blood cell formation. It is not something you inherited as a genetic mutation. Throughout your life, it occurs at various times. The reason for the change is unknown to medical experts.

 

White blood cell growth is disrupted by the mutation. Healthy blood cells and platelets are replaced by immature white blood cells, or promyelocytes, which proliferate uncontrollably.

 

 

Treatment Phases 

 

There are three stages to treatment: induction, consolidation, and maintenance. The different treatments based on risk:

 

• Induction: To put APL into remission, this phase seeks to eradicate enough leukemia cells. Remission denotes the absence of symptoms and the absence of leukemia-related test results. Non-chemotherapy, chemotherapy, and targeted therapy medicine are all included in the induction treatment. You will need to stay in the hospital for induction, which usually lasts four to six weeks.

 

• Consolidation: Post-remission therapy is a term your oncologist may use to describe the course of treatment. In addition to eradicating any remaining leukemia cells, consolidation therapy keeps Acute Promyelocytic Leukemia in remission. The induction treatment and this treatment both employ the same drugs. It is possible to complete eight months of treatment with twice-monthly sessions. There may be a four-week break period after the therapy phase. One alternative treatment option is to give pills or an intravenous (IV) line for medicine.

 

• Maintenance: As a result, less therapy is used than for consolidation and induction. Clients receive maintenance therapy for a full year on average.

 

 

Anthracyclines

 

These chemotherapeutic medications inhibit the proliferation of cancer cells by directly interfering with the nuclei of leukemic cells. There are several facets to the anthracycline class. The two most commonly used ones for treating APL are idarubicin (Idamycin®) and daunorubicin (Cerubidine®); these are usually used in combination with ATRA. Ninety percent of APL patients treated with ATRA and an anthracycline like idarubicin experienced initial remission rates. The combination of idarubicin and ATRA is referred to as AIDA.

 

 

All-Trans Retinoic Acid (ATRA)

 

It is necessary to take all-trans retinoic acid (ATRA), also known as tretinoin (Vesanoid®), orally. Including this vitamin A derivative in APL induction therapy is now required. ATRA removes abnormalities linked to PML/RARα. The significant decrease in leukemic blast cell concentration in the bone marrow caused by this medicine typically results in remission. At least 80% of the time, ATRA alone can produce a brief remission. For long-term remission following ATRA treatment, arsenic trioxide (ATO), and chemotherapy must be administered in addition to or in conjunction with one another. By starting treatment with lower leukemic cell counts and higher blood cell counts, ATRA usually reduces the negative effects of chemotherapy.

 

 

Stem Cell Transplantation

 

Very few patients with Acute Promyelocytic Leukemia still have minimum residual disease (MRD) after consolidation therapy. For some individuals, gemtuzumab ozogamicin (GO), or arsenic trioxide (Trisenox®) may be advantageous. Perhaps an autologous or allogeneic stem cell transplant is the next best step.

 

 

Antimetabolites

 

These chemotherapeutic drugs work by modifying the nucleotide sequences of DNA or RNA of the leukemia cells, thus halting the progression of the disease. Cytarabine (Cytosar-U®), an antimetabolite, may be utilized in the induction or consolidation phase for patients with High Risk APL (white cell count greater than 10,000/microliter at diagnosis).

 

 

Arsenic Trioxide (ATO)

 

The management of arsenic trioxide (Trisenox®) involves a gradual intravenous (IV) infusion. The combination of ATO and ATRA is better for patients with low-risk Acute Promyelocytic Leukemia than the prior standard of therapy, which included anthracyclines, according to some research studies. Since children and the elderly are more vulnerable to the side effects of anthracyclines, it may be especially advantageous for them to forgo additional chemotherapy medication.

 

For the treatment of newly diagnosed low-risk APL in people with PML/RARα gene expression or t(15;17) translocation, the FDA has approved arsenic trioxide in combination with tretinoin. ATO may be given daily in certain situations, or as part of a “treatment cycle,” it may be prescribed on certain days spaced out with rest days.

 

 

How do you proceed with Acute Promyelocytic Leukemia treatment in India?

 

 

Evaluation

 

Acute Promyelocytic Leukemia treatment begins with a visit to a specialist. The patient’s medical history, signs, and symptoms will be reviewed by the doctor.

 

Bone marrow biopsy and early blood testing

 

To find out the percentage of blasts, the physician suggests a bone marrow biopsy. The hip bone and surrounding area will be made numb prior to the surgeon inserting a needle to harvest bone marrow. After the sample is in the lab, a pathologist examines it to look for any anomalies.

The patient will also have tests for blood chemistry, coagulation, and other blood types in addition to the bone marrow biopsy.

 

Induction chemotherapy

The initial phase of the treatment is referred to as induction chemotherapy. Therapy is both severe and swift. It attempts to bring the body’s blasts down to normal levels by concentrating on them.

 

 

Repeated Bone marrow Biopsy

 

A second bone marrow biopsy is carried out after the induction phase. It helps assess the effectiveness of the initial treatment plan and the necessity of a bone marrow transplant.

 

High-risk AML: The patient is advised to have a bone marrow transplant if the physician observes no discernible change in the quantity of blasts.

 

Low-risk AML: If there is a discernible decrease in several blasts, the patient moves on to the subsequent chemotherapeutic cycle.

 

 

Consolidatory chemotherapy

 

The goal of the treatment is to eradicate the tiny number of blasts that remain in the bone marrow. It is administered in cycles with intervals of respite to allow the body to recuperate. For several months or years following consolidation, patients diagnosed with Acute Promyelocytic Leukemia require maintenance medication.

 

 

Bone marrow transplant

 

A bone marrow transplant involves the recipient receiving the cells from a donor. Bone marrow cells can be either autologous or allogenic, based on where they came from. The steps in this technique are as follows:

 

• A needle is inserted into the pelvic bone by the doctor after the area around the hip has been numbed.
• A second infusion of the processed material is given to the patient following a course of treatment.
• The bone marrow is taken into the laboratory after it has been aspirated using a needle.

 

 

Post-treatment care

 

The doctor may recommend particular drugs or therapies for post-treatment care and rehabilitation. To decide on the appropriate next course of treatment, basic testing is conducted.

 

 

Treatment Complications in Acute Promyelocytic Leukemia

 

Differentiation syndrome is the most frequent and harmful outcome. There exist several grave responses to APL medications. Usually, within the first three weeks after starting therapy or induction, reactions manifest. From minor to severe symptoms, some examples could be:

• The word “pleural effusion” refers to an accumulation of extra fluid around your heart and lungs.
• Renal failure is a term that can also refer to kidney failure.
• Low blood oxygen concentrations are referred to as hypoxia.
• Cough
• Low blood pressure, or hypotension.
• Fever without a known cause.
• Breathing difficulties, or dyspnea.
• Unwarranted weight rise.
• Arms, legs, and neck edema or swelling.

 

Your doctor may opt to stop treating you if differentiation syndrome is present. To reduce your body’s WBC count, you might be administered additional medications, such as hydroxyurea.

 

 

The estimated cost of Acute Promyelocytic Leukemia in India?

 

 

Medical care	Induction Chemotherapy	Consolidatory Chemotherapy	Bone Marrow Transplant (BMT)
Estimated Cost	Approx. 10,000 USD	Approx. 3500-4000 USD/month	Allogenic transplant (Half-match): 40,000 USD Allogenic transplant (Full-match): 22,000 USD Autologous transplant: 15,000 USD
Duration of treatment	14-15 days	12-16 weeks	6-11 days
Type of treatment	In-patient	Out-patient	In-patient/Out-patient

 

 

Choose GoMedii for affordable Acute Promyelocytic Leukemia Treatment in India

 

If you are looking for affordable Acute Promyelocytic Leukemia Treatment in India, you are at the right place and time! Trust GoMedii with your treatment; we assure you of a top-notch and hassle-free process.

 

We have tie-ups with one of India’s most reputed hospitals to get you the best treatment at an affordable cost. Furthermore, to avail of our packages, you can contact us on our Website and call us at +91-9599004311. Additionally, you can also email us at connect@gomedii.com. Our team will respond to you on a priority basis.

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