Hi doctor, My husband was diagnosed with APL before six years. He underwent treatment by following the pethema protocol for APL. After consolidation phase, BMA revealed there is still 7% of PML Rara using fish rara test while negative on cytogenetics. His doctor proceeded to his maintenance phase two years on ATRA, Mercaptopurine, and Methotrexate. For two years monitoring blood counts are within the normal range. BMA was done this year and revealed there is still 3% on FISH Rara. Is this considered a minimal residual disease? Or incomplete remission? Does he need to undergo chemo again or start a new ATRA?
Hello, Welcome to Chat Doctor forum. Sorry to hear about your husband\s diagnosis. He is having acute promyelocytic leukemia cancer and it is considered among favorable outcome leukemia. After starting chemotherapy complete remission includes less than 5% blast in bone marrow aspirate, ANC more then 1500, platelets more than 1 lakh, extramedullary hematopoiesis absent and molecular testing negativity. After consolidation chemotherapy, if cytogenetic study remains positive then prognosis cannot be considered good as compared to a negative cytogenetic leukemic patient after chemotherapy and it can be considered here as a minimal residual disease. Treatment was given in the right way along with proper chemotherapy and retinoic acid as well. But you have to discuss your case with your treating oncologist and he will guide you further about what is the future treatment protocol. I hope this helps. 