title: [Acute promyelocytic leukaemia].
abstract: BACKGROUND
  Acute promyelocytic leukaemia (APL) is a subtype of acute myeloid leukaemia (AML) with unique biological and clinical features and unique therapeutic requirements. The article provides a brief description of the development, pathophysiology, diagnosis and treatment of APL.
  
  
  METHODS
  The article is based on the authors' own experience and reviews of key articles and national and international guidelines.
  
  
  RESULTS
  The disease is caused by a single genetic event, namely the translocation t(15;17), which gives rise to the oncoprotein PML-RARA. Clinical and morphological characteristics arouse suspicion of the disease, and the diagnosis is verified by detecting the translocation. At the time of diagnosis most patients have severe coagulopathy and the predominant clinical manifestation is bleeding. Early mortality is due to severe haemorrhage, usually intracranial. Early treatment start with all-trans retinoic acid (ATRA) on suspicion of APL is essential to reduce this early mortality. ATRA is also an important part of continued treatment, in combination with anthracycline-based chemotherapy and possibly arsenic. After this treatment, the prognosis for disease-free long-term survival is > 90%. There are also safe and effective treatment options for elderly patients with complex comorbidities.
  
  
  CONCLUSIONS
  With APL it is particularly important to start disease-targeting therapy in the form of ATRA quickly because of the high risk of serious haemorrhages and high early mortality. If serious haemorrhages are avoided, the prognosis is very good.
authors.affiliation: King's College London School of Medicine Cancer Genetics Lab Department of Medical and Molecular Genetics Guy's Hospital London * Noverande adresse: Medisinsk avdeling, Haukeland universitetssjukehus.
authors.forename: Håkon
authors.initials: H
authors.lastname: Reikvam
authors.affiliation: Senter for medisinsk genetikk og molekylærmedisin Haukeland universitetssjukehus.
authors.forename: Randi
authors.initials: R
authors.lastname: Hovland
authors.affiliation: Medisinsk avdeling Haukeland universitetssjukehus og Klinisk institutt 2 Det medisinsk-odontologiske fakultet Universitetet i Bergen.
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Bruserud
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002884:Chromosomes, Human, Pair 15; D002886:Chromosomes, Human, Pair 17; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics / Q000473:pathology; D015514:Oncogene Proteins, Fusion / Q000235:genetics; D014178:Translocation, Genetic; D014212:Tretinoin / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D015514:Oncogene Proteins, Fusion; C093476:promyelocytic leukemia-retinoic acid receptor alpha fusion oncoprotein; D014212:Tretinoin