ACUTE PROMYELOCYTIC LEUKEMIA IN PREGNANCY - ALL-TRANS-RETINOIC ACID AS A NEWER THERAPEUTIC OPTION

Background: Acute promyelocytic leukemia is a unique subset of acute m yelogenous leukemia, characterized by a neoplastic proliferation of pr omyelocytes and a prompt response to all-trans retinoic acid (tretinoi n), which induces differentiation of immature leukemic promyelocytes i nto mature neutrophils. Because of the high incidence of disseminated intravascular coagulation (DIC) associated with acute promyelocytic le ukemia and the danger of exacerbation of DIC with pregnancy, managemen t of acute promyelocytic leukemia during pregnancy requires prompt and careful attention. Case: A 29-year-old woman in her third trimester w as diagnosed with acute promyelocytic leukemia and DIC. The infant was delivered by cesarean and the mother was successfully treated with tr etinoin, inducing the leukemic promyelocytes to differentiate into mat ure granulocytes and possibly reversing the DIC. Conclusion: If the fe tus can be delivered safely, tretinoin as a single agent is an option for the initial treatment of maternal acute promyelocytic leukemia bec ause it does not suppress the bone marrow and may ameliorate DIC. Beca use of the danger of hyperleukocytosis, chemotherapy should be added i nitially if the white blood cell count is greater than 5000/mu L. If t he fetus cannot be delivered at a viable stage, conventional cytotoxic chemotherapy is the alternative option.