"The answer to all my low blood cell counts final resolved on August 1st. In the words of my Hematologist: “There was particular concern for prostate cancer metastatic to the marrow and therefore he was scheduled for a bone marrow biopsy on 8/1/2019. Surprisingly, aspirate returned notable for presence of60% promyelocytes and given concern for APL he was contacted and directed back to the ED for admission. His marrow ultimately was consistent with APL (acute promyelocytic leukemia); karyotype showed the t(15;17) translocation in 19 of 20 metaphases, RT_PCR for PML-RARA was positive, molecular testing confirmed presence of a FLT3ITD. He was initiated on ATRA on 8/1/2019 and combination therapy with ATRA and arsenic trioxide (ATO) as per the LoCoco regimen was begun on 8/3/2019.” Thus started 34 days in isolation, three units of blood and platelets in the first week, helped a lot towards digging me out of the hole. The quick start of ATRA (All-trans Retinoic Acid, generic name: Tretinoin, trade name: Vesanoid) was in case APL was the diagnosis. When APL was confirmed, ATO (Arsenic Trioxide) infusion was started through a pic line, (the ATO/ATRA continued 28 days). A second bone marrow biopsy was done to show remission had been achieved. This was the Induction phase. On discharge from the hospital (with a dual lumen port line), I had a 4-week break from Chemo and then the Consolidation phase began: 4 weeks on ATO, 14 days on ATRA. This is phase will entail 4 complete cycles, with bone marrow biopsy between cycle 2 & 3. This will take me out to mid-April. The one thing that encourages me is the 90% cure rate, and that the10% usually occurs in the 1st 48 hours. The Prostate cancer treatment has been on hold (except for the Lupron shots). PSA on discharge from the hospital was 3.6, now at 16.3. re-staging scans and consult with GU oncologist first week of January (APL treatment is 1st priority) During my “incarceration” I did a lot of reading on Leukemia The following is from the Leukemia Association of Australia (it had the clearest description of APL in my opinion). “Acute promyelocytic leukemia (APL) is a rare sub-type of acute myeloid leukemia (AML) and is sometimes referred to as AML M31. APL accounts for only 10% of all AML diagnoses. In APL, immature abnormal neutrophils (a type of white blood cell) known as promyelocytes accumulate in the bone marrow. These immature cells are unable to mature and function like healthy mature white cells. The accumulation of these immature cells in the marrow inhibits normal cell production, which results in lower numbers of blood cells circulating the body. In most cases the causes of APL remain largely unknown but it is thought to result from damage to one or more of the genes that normally control blood cell development. Factors that may put some people at an increased risk include exposure to: • prior chemotherapy or radiotherapy, although the risk of developing APML following treatment for prior cancer is rare. When it does occur, it is referred to as treatment-related APL. • bone marrow disease. People with prior diseases of the bone marrow have an increased risk of developing secondary APL. Generally, however, those with pre-existing bone marrow disorders develop AML. There appears to be no increased risk of developing APML as a result of environmental or occupational hazards.”"