THROMBOSIS IN PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA TREATED WITHAND WITHOUT ALL-TRANS-RETINOIC ACID

Laboratory evidence of disseminated intravascular coagulation (DIC) an d/or fibrinolysis is present in the majority of patients with acute pr omyelocytic leukemia (APL). Historically, early hemorrhagic death (EHD ) occured in 10% to 30% of patients treated with chemotherapy. All-tra ns retinoic acid (ATRA), a differentiating agent, has a CR rate above 80% in patients, with ATRA-associated leukocytosis. We studied thrombo tic events in this population and compared it to patients treated with chemotherapy alone. The results of studies using ATRA in patients wit h APL were reviewed, Patients received ATRA 45-50 mg/m(2) orally in tw o divided doses daily until complete remission. In newly diagnosed pat ients, Idarubicin 12 mg/m(2)/day was given intravenously for 4 to 5 da ys beginning on the fifth day of ATRA therapy or when the white blood cell count (WBC) was over 10 x 10(3)/mu l. Thrombotic complications we re noted in 3 of 31 patients during induction, Two died from thromboti c events during therapy with multiple thromboses documented at autopsy . ATRA syndrome was suspected in 2 of the patients with thromboses and only 1 of the patients without thrombosis. In previous studies, 1 of 25 APL patients treated with chemotherapy alone had thrombotic events during therapy. In conclusion, treatment of APL with ATRA may decrease the incidence of hemorrhagic complications, but does not eliminate th rombosis. While thrombotic events were not significantly increased in patients treated with ATRA, they were more common in patients suspecte d of having ATRA syndrome.