Therapeutic management of acute promyelocytic leukemia
Appropriate treatment of acute promyelocytic leukemia (APL) requires genetic confirmation of the diagnosis by fluorescence in situ hybridization (FISH) or polymerase chain reaction (PCR) (promyelocytic leukemia/retinoic acid receptor [PML-RAR+]) and should be performed in specialized centers with experience in APL treatment. The high cure rate of APL can only be realized when therapy is initiated as soon as possible and therefore diagnosis must also be made as early as possible. As pancytopenia can occur in APL, additional coagulation abnormalities such as hyperfibrinolysis should lead to immediate bone marrow diagnostics. When the marrow is packed, smears have to be carefully examined for the presence of Fagott cells. The less frequent hypogranular variant (M3v) has a characteristic cytomorphology and may not be overlooked.