ORAL ALL-TRANS-RETINOIC ACID (ATRA) - ADM INISTRATION IN INTUBATED PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA

In acute promyelocytic leukemia (APL), disseminated intravascular coag ulation is frequently observed. Massive alveolar bleeding can lead to respiratory insufficiency, requiring tracheal intubation and mechanica l ventilation. Today all-transretinoic acid (ATRA) is part of inductio n chemotherapy in acute promyelocytic leukemia. The administration of ATRA is oral. No intravenously administered form is available. ATRA ca n be administered to intubated patients in the following manner: the d aily amount of ATRA is placed in a sterile 50 ml tube. After addition of about 20 ml of sterile water the tube is heated in a waterbath to a temperature of 37 degrees C until the capsules melt and the suspensio n is completely liquid. The resulting oily fluid is then administered via nasogastric tube. We have treated 2 patients with acute promyelocy tic leukemia intubated due to massive alveolar bleeding in this manner , and have observed a differentiation of promyelocytes to granulocytes and complete remission in both patients, indicating that the ATRA adm inistered had been resorbed intestinally.