RETINOIDS IN THE TREATMENT OF ACUTE PROMYELOCYTIC LEUKEMIA - REVIEW OF THE LITERATURE

Retinoids are derivates of vitamin A. They play an imortant role in em bryogenesis and differentiation of normal cells. All-trans retinoic ac id (ATRA, Tretinoin) and 13-cis retinoid acid (cRA, Isotretinoin) are the most important isomers. The first treatment with retinoids in a pa tient with an acute promyelocytic leukemia (APL) is reported in 1983. Since 1988 studies are done investigating the effect of retinoids in A PL. These studies demonstrate, that retinoids can achieve a high remis sion rate in patients with APL but without curing pa tients. A combina tion with chemotherapy is always necessary. The main advantage of usin g retinoids in this disease is a rapid improvement of the hemostatic d isorder and the absence of an aplastic phase. Side effects of retinoid s are those of the hypervitaminosis A syndrome and have to be consider ed in every patient treated with this durg. The addition of alpha-Toco pherol seems to ameliorate the toxicity of retinoic acid (RA). The the oretical background of the treatment with retinoids in APL as well as the clinical studies done so far are explained in detail.