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 APML differentiation syndrome:

Treatment of acute promyelocytic leukaemia (APML) with arsenic trioxide (ATO) and/or all-trans retinoic acid (ATRA) can induce an APML differentiation syndrome. This is potentially fatal. Prophylaxis with prednisolone is recommended (see protocol) APML differentiation syndrome may still occur despite prophylaxis, in which case early recognition is essential and prednisolone should be changed to treatment with high dose intravenous steroids (e.g. dexamethasone 10 mg IV twice daily) at the earliest signs or symptoms. Link to APML differentiation syndrome document.

Patients with leukaemia should be considered for inclusion into clinical trials. Link to ALLG website and ANZCTR website.

The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQ reference committee regarding their views of currently accepted approaches to treatment. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information sources. Use is subject to eviQ’s disclaimer available at

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18 May 2022