Acute promyelocytic leukemia in pregnancy: all-trans retinoic acid as a newer therapeutic option.

Abstract

Acute promyelocytic leukemia is a unique subset of acute myelogenous leukemia, characterized by a neoplastic proliferation of promyelocytes and a prompt response to all-trans retinoic acid (tretinoin), which induces differentiation of immature leukemic promyelocytes into mature neutrophils. Because of the high incidence of disseminated intravascular coagulation (DIC) associated with acute promyelocytic leukemia and the danger of exacerbation of DIC with pregnancy, management of acute promyelocytic leukemia during pregnancy requires prompt and careful attention. A 29-year-old woman in her third trimester was diagnosed with acute promyelocytic leukemia and DIC. The infant was delivered by cesarean and the mother was successfully treated with tretinoin, inducing the leukemic promyelocytes to differentiate into mature granulocytes and possibly reversing the DIC. If the fetus can be delivered safely, tretinoin as a single agent is an option for the initial treatment of maternal acute promyelocytic leukemia because it does not suppress the bone marrow and may ameliorate DIC. Because of the danger of hyperleukocytosis, chemotherapy should be added initially if the white blood cell count is greater than 5000/microL. If the fetus cannot be delivered at a viable stage, conventional cytotoxic chemotherapy is the alternative option.