Anurag Basu, the director of the blockbuster movie, ‘Barfi’, fought back acute Promyelocytic Leukemia (a type of blood cancer) in the year 2004. When he was diagnosed, the prognosis was bleak and he was told he had just a couple of months to live, but he fought back and has been cancer free for 14 years now. WHAT IS APML? Acute promyelocytic leukemia (APML, APL) is a subtype of acute myeloid leukemia (AML), a cancer of the white blood cells. APML is characterised by an accumulation of immature abnormal neutrophils (a type of white blood cell) known as promyelocytes in the bone marrow. The accumulation of these immature cells in the marrow interferes with and inhibits the production of normal cells, resulting in lower numbers of blood cells circulating the body. WHO GETS AML? The incidence of AML increases as one grows older, but it can happen at any age. It is a little more common in men than in women. WHAT CAN UP YOUR RISK? There are some known risk factors for acute myeloid leukemia (AML): Smoking Smoking is a proven risk factor for AML. Although smoking is strongly linked to lung, throat and mouth cancer, few people realize that it can also affect cells which are not in direct contact with tobacco smoke. The cancer causing chemicals in tobacco smoke are absorbed by the lungs and spread through the bloodstream to other parts of the body. Inheriting a genetic mutation Genetic mutations (abnormal changes) present at birth cause some syndromes which are linked to an increased risk of AML. Blood disorders Certain blood disorders such as polycythemia vera, thrombocythemia, and idiopathic myelofibrosis increases the risk for some people. Certain chemicals for example, benzene which is found in cigarette smoke, in rubber industries and chemical plants etc. Certain chemotherapy drugs, Patients who have been treated with certain chemotherapy drugs known as alkylating agents such as cyclophosphamide, mechlorethamine, procarbazine, chlorambucil etc are at greater risk. Exposure to certain chemicals and harmful substances: Exposure to electromagnetic fields, diesel, gasoline, and some chemicals, solvents, herbicides or pesticides, although these factors have not been linked conclusively to AML. Research is being done in these areas. Radiation High-dose radiation exposure such as being a survivor of an atomic bomb blast or nuclear reactor accident, as well as radiation treatment for cancer increases the risk of developing AML. The risk varies based on the amount of radiation given and the area which was treated. Compromised immune system for eg., due to an organ transplant WHAT SYMPTOMS SHOULD YOU WATCH OUT FOR? The main symptoms of APML are caused by a lack of normal blood cells and some symptoms can be non specific or general ones. Some common symptoms are: Tiredness/Fatigue Fever Shortness of breath which gets worse with exercise Headaches Bleeding from the nose Bleeding gums Bruising Bone pain or tenderness Heavy menstrual periods Pale Skin Swollen gums Weight loss Sometimes people have no symptoms at all and APML is diagnosed during a routine blood test. Some of the symptoms listed above may also be seen in other illnesses like viral infections, so it is important to see a doctor if you have any of these problems and they are persisting, so that you can be examined and treated properly. WHAT ARE THE TREATMENT OPTIONS FOR APML? The main treatment for most types of AML is chemotherapy, sometimes along with a targeted therapy drug. This might be followed by a stem cell transplant. Besides standard chemotherapy drugs, other drugs may be used to treat patients with acute promyelocytic leukemia (APL). The treatment for APML involves the use of a drug called all-trans retinoic acid (ATRA) which is a derivative of vitamin A, and it works by making the immature promyelocytes mature properly. This drug is used in combination with standard chemotherapy and has improved survival rates for people diagnosed with APML. Surgery and radiation therapy are not major treatments options for AML, but they may be used in special circumstances. As in all other types of cancer, treatment choices will be guided by: Age and overall health The type of AML the patient has The possible side effects from treatment In most cases AML can progress quickly if not treated, so it’s important to start treatment as soon as possible after the diagnosis is made. But it’s also very important to make an informed decision.