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APML — RACP Adult Medicine MCQ

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EasyHaematologyAPMLRACP Adult Medicine

A 30-year-old woman presents with DIC, pancytopenia, and bone marrow showing hypergranular promyelocytes with Auer rods. FISH confirms PML-RARA fusion [t(15;17)]. She has coagulopathy with fibrinogen 0.8 g/L. What is the most appropriate initial treatment?

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Correct answer: E — All-trans retinoic acid (ATRA) plus arsenic trioxide

Acute promyelocytic leukaemia (APML) with t(15;17)/PML-RARA is treated with ATRA plus arsenic trioxide (ATO) as first-line for non-high-risk patients (APL0406, AML17 trials). This chemotherapy-free approach achieves cure rates >95%. Aggressive blood product support (fibrinogen >1.5 g/L, platelets >30–50) is essential due to the DIC coagulopathy. ATRA must be started immediately upon suspicion.

Reference: ALLG – 2024 – APML Guidelines; Lo-Coco 2013 APL0406 Trial