Use of trans-retinoic acid in the treatment of acute promyelocytic leukemia.
OBJECTIVE
To discuss acute promyelocytic leukemia (APL) and review the literature concerning differentiation treatment of APL with trans-retinoic acid (t-RA).


METHODS
English-language articles concerning APL or its treatment with t-RA were identified with a MEDLINE search.


METHODS
All studies available at the time of article preparation, which addressed t-RA treatment in APL, were selected.


METHODS
Data extraction and assessment were performed subjectively by the authors. An extensive discussion of specific study details is included in the article.


RESULTS
APL is a unique subset of acute myelogenous leukemia and is typified by an accumulation of malignant promyelocytes in the bone marrow. Within the granulocyte cell cycle of a patient with APL, differentiation has been halted at the level of the promyelocyte, preventing formation of mature granulocytes. Upon treatment with traditional cytotoxic chemotherapy, complete remission rates of approximately 70 percent, with a five-year survival ranging from 25 to 40 percent have been achieved. In most patients with APL, a characteristic chromosomal t(15q+;17q-) translocation has been found, which may be responsible for the production of an aberrant retinoic acid receptor-alpha. Therefore, t-RA induction therapy has been investigated and has produced promising results. Administration of t-RA in dosages of 45-100 mg/m2/d has induced complete remissions. The apparent mechanism of t-RA is the induction of promyelocyte differentiation and maturation. The most common adverse effects noted have been dry skin, cheilitis, and headaches.


CONCLUSIONS
Upon consideration of the initial trials, t-RA appears to be a promising and unique treatment for APL.
Dulaney
A M
AM
Duke University Medical Center, Durham, NC.
Murgatroyd
R J
RJ
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D002986:Clinical Trials as Topic; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D012074:Remission Induction; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D014212:Tretinoin