LEUKEMIA-CUTIS IN ACUTE PROMYELOCYTIC LEUKEMIA - REPORT OF 3 CASES AFTER TREATMENT WITH ALL-TRANS-RETINOIC ACID

Acute promyelocytic leukemia (APL) is a distinct form of acute myeloge nous leukemia characterized by an abundant number of abnormal progranu locytes, a severe coagulopathy and a distinct chromosomal abnormality t(15;17). Recently all-trans retinoic acid (ATRA) has been shown to in duce complete remissions in APL. We report three patients with APL tre ated with ATRA, who at the time of relapse had leukemic infiltration o f the skin (leukemia cutis), a manifestation which we had not seen pre viously in over 60 patients with APL treated with chemotherapy alone a nd has only rarely been reported in the literature. We hypothesize tha t ATRA treatment for APL may be associated with an increased incidence of extramedullary disease at the time of relapse, which may be mediat ed through an increase in expression of adhesion molecules. Careful ob servation for extramedullary relapses in patients treated with ATRA fo r APL will be needed to confirm our observation.