ADVANTAGE OF INDUCTION THERAPY WITH ALL-TRANS-RETINOIC ACID IN ACUTE PROMYELOCYTIC LEUKEMIA IN A COUNTRY WITH LIMITED TRANSFUSION RESOURCES- A MALAYSIAN EXPERIENCE

Induction of remission of acute promyelocytic leukaemia (APL) needs in tensive blood support (16) to prevent bleeding attributed to dissemina ted intravascular coagulation. Between 1989 and 1991, at the Universit y Hospital in Kuala Lumpur, Malaysia, the remission rate of APL was on ly 27% with conventional chemotherapy as a result of inadequate transf usion resources. The use of all trans retinoic acid in induction thera py followed by consolidation and maintenance chemotherapy has improved the situation dramatically. Twelve patients entered the study. Ten pa tients achieved remission (83%), indicating how ATRA had significantly improved the results (p = 0.003). Blood component transfusions were a lso significantly reduced (p = 0.003). Two ethnic Chinese patients dev eloped pulmonary leucostasis. Published Chinese (2, 6) and Japanese (1 1) studies have not reported this serious adverse effect. We can now s tate that leucostasis is not a phenomenon limited to the Western popul ation. ATRA has proved to be extremely beneficial for patients at this centre. Early analysis also suggests that consolidation and maintenan ce chemotherapy has prolonged remission duration. ATRA should be made available for the treatment of APL in all countries where there are in adequate transfusion services.