Acute promyelocytic leukemia and pregnancy

In acute promyelocytic leukemia (APL), the use of all-trans-retinoic acid ( ATRA) as a differentiating agent induces complete remission in a high perce ntage of patients. In pregnancy, however, this drug bears the risk of sever e teratogenicity to the child. We report the case of a 23-yr-old woman at 2 1 weeks' gestation suffering from APL. She was treated with ATRA (45 mg/m(2 )) for 40 d and two courses of standard chemotherapy. The mother achieved c omplete remission within 22 d of treatment. Fetal development was normal, a nd a healthy premature girl was born in the 35th week of pregnancy. In a re view of the literature we have identified 14 cases of APL in pregnancy trea ted with ATRA alone or in combination with chemotherapy. ATRA has been used as early as in the 3rd week of gestation and in no case have malformations or other teratogenic effects occurred. Side-effects, however, ranged from fetal cardiac arrythmias to induction of labour. Although known to exhibit severe teratogenic effects during the first trimester of pregnancy, ATRA se ems to be reasonably safe during the second and third trimesters in the tre atment of APL. However, careful obstetric follow-up is mandatory regarding fetal cardiac complications.