The first 60 days: Acute promyelocytic leukaemia

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

• PathologistNamed in the standard of care for: Molecular relapse.
• Medical oncologistNamed in the standard of care for: Suspected APL, first hours, Low- and intermediate-risk, High-risk, Molecular relapse.
• Transplant and cell therapy teamNamed in the standard of care for: Molecular relapse.
• Palliative and supportive care teamNamed in the standard of care for: Suspected APL, first hours, Low- and intermediate-risk.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1. 1.Low- and intermediate-riskNCCN Guidelines: Acute Myeloid Leukemia

   All-trans retinoic acid plus arsenic trioxide induction and consolidation without chemotherapy (APL0406); dexamethasone prophylaxis or treatment for differentiation syndrome.

   Tretinoin (all-trans retinoic acid, ATRA)Arsenic trioxideDexamethasone
2. 2.High-riskNCCN Guidelines: Acute Myeloid Leukemia

   All-trans retinoic acid plus arsenic trioxide with idarubicin or gemtuzumab ozogamicin added during induction to control the white count.

   Tretinoin (all-trans retinoic acid, ATRA)Arsenic trioxideIdarubicinGemtuzumab ozogamicin
3. 3.Suspected APL, first hoursNCCN Guidelines: Acute Myeloid Leukemia

   Start all-trans retinoic acid on morphological suspicion; transfuse platelets and fibrinogen to targets; avoid invasive procedures until coagulopathy is controlled.

   Tretinoin (all-trans retinoic acid, ATRA)Transfusion support and anaemia management
4. 4.Molecular relapseNCCN Guidelines: Acute Myeloid Leukemia

   Arsenic-based salvage to molecular remission, then autologous transplant if PML::RARA negative, allogeneic transplant if not.

   Arsenic trioxideAutologous stem cell transplant (high-dose therapy)Allogeneic stem cell transplantation

Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

• Free in oncologyFree testing, helplines, rides and lodging, second opinions and trial travel help, with who is eligible.
• Financial helpManufacturer programmes, national schemes and charities by country and product.
• Second opinionExpert centres for this cancer in your country and how referral works.

• Acute promyelocytic leukaemia: the full pageAcute promyelocytic leukaemia is caused by a single fused gene that freezes blood cells at an immature stage and triggers dangerous bleeding. Two non-chemotherapy drugs, a vitamin A derivative and arsenic trioxide, make the cells mature and cure more than nine in ten patients.
• One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
• Treatment sequencingWhich treatment tends to follow which, line by line.
• NavigatorStandard of care for your stage, what you have tried, and trials near you.