EXTRAMEDULLARY INVOLVEMENT IN PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA - A REPORT OF 7 CASES

Citation
V. Liso et al., EXTRAMEDULLARY INVOLVEMENT IN PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA - A REPORT OF 7 CASES, Cancer, 83(8), 1998, pp. 1522-1528
Citations number
41
Categorie Soggetti
Oncology
Journal title
CancerACNP
ISSN journal
0008543X
Volume
83
Issue
8
Year of publication
1998
Pages
1522 - 1528
Database
ISI
SICI code
0008-543X(1998)83:8<1522:EIIPWA>2.0.ZU;2-G
Abstract
BACKGROUND, Extramedullary involvement is only occasionally observed i n patients with acute promyelocytic leukemia (APL) but has been said t o occur more frequently after treatment with all-trans retinoic acid ( ATRA) than after treatment with cytotoxic drugs. In the literature, 37 well-documented cases have been reported. METHODS. The authors report 7 patients with extramedullary APL documented by cytologic, phenotypi c, and molecular analyses among 120 adult APL patients referred to two different institutions during a period of 9 years. RESULTS. In this A PL series, extramedullary disease (EMD) occurred in 7 of 120 cases (5. 8%). The extramedullary sites were the skin in five patients, the cent ral nervous system in one, and the lymph nodes in one. Molecular analy sis of the PML/RAR alpha rearrangement was performed on four samples o f skin and one of CSF; all patients exhibited the same molecular patte rn in the bone marrow (BM) and EMD sites. Of 120 patients, 61 were tre ated with ATRA plus chemotherapy and 59 with chemotherapy alone. Relap ses were observed in 38 patients, 6 of whom had EMD; 1 patient had dev eloped EMD at the onset of APL. Of the relapsed EMD cases, 2 of 61 pat ients had received ATRA plus chemotherapy and 4 of 59 had received che motherapy alone. CONCLUSIONS. There is some controversy as to whether treatment of APL with ATRA may predispose patients to the development of extramedullary relapse. The data from this study do not contain evi dence that EMD may occur more frequently in APL patients treated with ATRA. Cancer 1998;83:1522-8. (C) 1998 American Cancer Society.