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)