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Acute promyelocytic leukemia
Reviewed by Medicinsk Expert•Last updated: 2026-10-22•Condition

Acute promyelocytic leukemia

Acute promyelocytic leukemia is a form of acute myeloid leukemia characterized by the accumulation of immature white blood cells in the bone marrow, leading to a shortage of healthy blood cells.

Overview

Acute promyelocytic leukemia is a cancer of the blood-forming tissue. In healthy bone marrow, hematopoietic stem cells produce red blood cells, white blood cells, and platelets. In this condition, immature white blood cells known as promyelocytes accumulate in the bone marrow, causing a shortage of normal blood cells.

Symptoms

The overgrowth of promyelocytes and the resulting lack of healthy blood cells lead to several signs and symptoms:

  • Abnormal bleeding and bruising: Susceptibility to bruises, petechiae (small red dots under the skin), nosebleeds, bleeding gums, hematuria (blood in the urine), or excessive menstrual bleeding.
  • Anemia: Low red blood cell counts can cause pallor (pale skin) and fatigue.
  • Infection: Frequent infections and slow healing due to a loss of normal white blood cells.
  • Pain: Leukemic cells may spread to bones and joints.
  • General symptoms: Fever, loss of appetite, and weight loss.

This condition is most often diagnosed around age 40, though it can occur at any age.

Causes

The condition is caused by a somatic mutation—a change acquired during a person's lifetime that is not inherited. It involves a translocation between chromosomes 15 and 17, written as t(15;17).

  • This translocation fuses part of the PML gene with part of the RARA gene.
  • The resulting PML-RARα protein interferes with the normal function of both the PML and RARα proteins.
  • The RARα protein normally helps regulate the maturation of white blood cells, while the PML protein acts as a tumor suppressor.
  • The fusion protein causes blood cells to become stuck at the promyelocyte stage, where they proliferate abnormally.

The PML-RARA gene fusion accounts for up to 98 percent of cases.

Frequently Asked Questions

Look for sudden or severe bleeding (nosebleeds, gum bleeding, heavy menstrual periods), unexplained bruising, persistent fever, shortness of breath, or new bone/joint pain. These symptoms can signal a rapid drop in blood cells and need urgent evaluation.
Most patients see neutrophil recovery within 2–3 weeks and platelet recovery by 4–6 weeks after induction. Once blood counts are stable and you’re off high‑dose steroids, many can resume light activities; full return to work or school usually occurs 2–3 months post‑remission, depending on individual recovery and side‑effect profile.
The presence of the PML‑RARα fusion gene makes the leukemia highly responsive to all‑trans retinoic acid (ATRA) and arsenic trioxide. These agents force the abnormal promyelocytes to mature, dramatically improving remission rates compared with standard chemotherapy alone.
Generally, no strict diet is required, but you should avoid high‑vitamin A supplements (they can increase toxicity) and stay well‑hydrated. Some patients experience differentiation syndrome, so a low‑salt diet may help control fluid retention, but follow your oncologist’s specific guidance.
Source: MedlinePlus, National Library of Medicine

MedlinePlus brings together authoritative health information from the National Library of Medicine (NLM), the National Institutes of Health (NIH), and other government agencies and health-related organizations.

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