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Successful treatment of acute promyelocytic leukemia in pregnancy with all-trans retinoic acid

Leukemia volume 15, pages 1665–1666 (2001)Cite this article

Management of APL during pregnancy represents a significant problem because it is usually associated with coagulopathy and the potential teratogenic effect of most chemotherapeutic agents. There have been fewer than 20 reported cases of acute promyelocytic leukemia (APL) in pregnancy treated with all-trans retinoic acid (ATRA) alone or in combination with cytotoxic chemotherapy. Even though ATRA has been shown to induce complete remission in most cases of newly diagnosed APL with rapid resolution of disseminated intravascular coagulation, its effectiveness and safety in pregnancy has not been confirmed due to limited clinical experience. We herein report a patient diagnosed as APL at the 25th week of gestation who was successfully treated with ATRA. Treatment with ATRA alone resulted in hematological remission on day 25 of therapy with no significant adverse effect. A healthy infant was delivered by Caesarean section at the 34th week of gestation. To date, the patient is still in complete remission and the growth and development of her 9-month-old infant has been without any complication.

A 41-year-old woman, gravida 7, para 3 + 3, presented at the 25th week of gestation with fatigue and fever for 2 weeks. The maternal hemoglobin level was 4.0 g/dl, platelet count 12 × 109/l and leukocyte count 0.7 × 109/l with a differential of 40% promyelocytes, 20% segmented neutrophils, and 40% lymphocytes. Morphological, immunophenotyping and cytogenetic studies of the bone marrow samples were consistent with the diagnosis of APL. The INR, partial thromboplastin time, and serum fibrinogen were within normal limits. The patient received broad-spectrum antibiotics resulting in resolution of the fever. ATRA was initiated at a dose of 45 mg/m2/day orally. Her blood counts gradually improved and she did not require further transfusion support after 19 days of ATRA therapy. Eleven units of irradiated packed red cells and 13 units of platelets were used. Ultrasound examination at the 32nd week of gestation revealed a normal-appearing fetus, and a low-lying placenta. Dexamethasone 12 mg twice a week was administered for fetal pulmonary maturity. The hemoglobin was 10.2 g/dl, platelet 198 × 109/l and leukocyte 3.8 × 109/l with normal differential count by day 25 of ATRA therapy. No complication associated with ATRA was observed. Treatment with ATRA was continued for 56 days until a live baby girl was delivered by Caesarean section at the 34th week of gestation. The birth weight was 2610 g and there were no physical abnormalities detected. Blood tests including blood count and cholesterol levels were normal. The maternal postpartum course was uneventful and she was discharged home on postpartum day 5 on ATRA therapy. Two weeks after delivery, a repeat bone marrow confirmed complete hematological and cytogenetic remission. The patient has since received two courses of standard consolidation and maintenance chemotherapy. At the time of writing, the patient and her 9-month-old child are presently well.

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Authors and Affiliations

  1. Division of Haematology and Haemopoietic Stem Cell Transplantation, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia

    SAW Fadilah, CS Keng, MA Jamil & S Singh

  2. Department of Obstetric and Gynaecology, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia

    AZ Hatta

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  1. SAW Fadilah
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Fadilah, S., Hatta, A., Keng, C. et al. Successful treatment of acute promyelocytic leukemia in pregnancy with all-trans retinoic acid. Leukemia 15, 1665–1666 (2001). https://doi.org/10.1038/sj.leu.2402250

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