by Kimberly Allen, RN
Ever since coach Chuck Pagano of the Indianapolis Colts was diagnosed with leukemia people have been asking me questions like how many kinds of leukemia are there? Well, there are four main categories or types of leukemia, acute myeloid leukemia or AML, acute lymphoblastic leukemia or ALL, chronic myeloid leukemia or CML, and chronic lymphocytic leukemia or CLL. There are also subtypes in each category. The type of leukemia the coach was diagnosed with is called acute promyelocytic leukemia. It is a very distinct subtype of AML or acute myeloid leukemia. One of the things that makes this type of leukemia different is that unlike other leukemia’s this type is nearly identical in both children and adults.
The various types of leukemia’s are diagnosed by what type of white blood cell is affected as well as how fast the cancer progresses. Acute means that the leukemia is aggressive and spreads rapidly. Acute promylocytic leukemia is an acute leukemia affecting the white blood cell known as the myeloid cell. In the US acute promyelocytic leukemia is the type diagnosed in up to 15% of all adult leukemia’s, and is considered to be one of the “rare” cancers. This type of leukemia in adults tends to develop around 40 years of age, where as other adult leukemia’s usually develop around 70 years of age. This type of leukemia affects both men and women equally, but has shown a high incidence rate in Hispanics.
All of our blood cells are produced in our bone marrow. Every type of blood cell is produced by stem cells, or “mother cells”, in our bone marrow. New blood cells are constantly being reproduced in order to replace the ones that are dying off and/or damaged. It is a highly complex and controlled process that ensures there is the correct amount of each type of blood cell in our body. Leukemia causes this highly controlled process to breakdown. In the case of acute promyelocytic leukemia it’s the myeloid cells that mutate reproducing abnormal cells. In acute promyelocystic leukemia the myeloid cells reproduce but never mature, therefore they can’t leave the marrow and enter the bloodstream. This causes a buildup of immature white blood cells in the marrow which leads to two problems, one there isn’t enough white blood cells circulating to maintain the immune system leaving you prone to infections and two the build up of immature white cells in the bone marrow prevents the production and growth of other blood cells including red blood cells and platelets, which in turn leads to anemia and poor clotting ability.
As a rule the symptoms of acute promyelocytic leukemia are the same as those seen in other types of AML, including weakness and fatigue as well as easy bruising and bleeding. The symptom that distinguishes acute promylocytic leukemia from other types of AML is the degree of bleeding or coagulopathy. The bleeding is the result of not enough platelets in your bloodstream. This can be a serious problem requiring immediate medical attention. Other symptoms include bone pain resulting from the build up of abnormal/cancer cells in the bone marrow. As the acute promylocytic leukemia spreads you could also experience swollen glands as the cancer cells build up in your lymph nodes. As the cancer causes your liver and spleen to well you may experience abdominal pain.
There was a time when acute promyelocytic leukemia was 100% fatal, however, fortunately today it is one of the most treatable of the leukemia’s. The treatment for acute promyelocytic leukemia is different than that for other types of AML’s. The two most effective and commonly used drugs for acute promyelocytic leukemia are all-trans retinoic acid or ATRA and arsenic trioxide. At least 80% of patients receiving ATRA enter into a short term remission. Then after the initiation of treatment and short term remission ATRA is combines with Chemotherapy to achieve long term remission. In the past arsenic trioxide (ATO) was used of you didn’t respond to treatment with ATRA, however, in recent years researchers have found that by starting treatment with both ATRA and ATO as well as chemotherapy patients are reaching the 5 year survival rates close to 100%.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.