Acute Promyelocytic Leukemia (APL)

We discussed a case about a young man who was previously healthy, presenting with subacute-chronic fevers + chills + malaise + unintentional weight loss + night sweats + bruising and acute bleeding from the mouth, found to have acute promyelocytic leukemia.

APL is a variant of AML

  • Adults (20-50s, w/ median in 40s)
  • Hallmark is atypical promyelocytes in blood of bone marrow
  • t(15;17) translocation & PML-RARA gene fusion → blocks myeloid differentiation, so myeloid cells are stuck at the promyelocyte stage- increased risk for DIC & hyperfibrinolysis → hemorrhage (esp brain bleeds), so it is important to do a good neuro exam!
  • Treatment: ATRA, even if only suspect APL (don’t need to wait for confirmatory test results)

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