[Complete remission of acute promyelocytic leukemia accompanied by DIC in an elderly patient treated with all-trans retinoic acid].
In this paper we report on a 74-year-old female patient who was suffering from acute promyelocytic leukemia (APL) and who, upon admission to our hospital on February 20, 1992, was also found to be stricken with disseminated intravascular coagulation (DIC). The DIC, however, was quickly arrested by administration of heparin and there was no exacerbation. Also, on admission her peripheral blood leukocyte count was 700/ul, but after oral administration of all-trans retinoic acid (ATRA) (45 mg/m/day) was begun on February 22, this count gradually increased and peaked at 35,200/ul on March 7. Some of these matured leukocytes revealed dysplastic features; some had Auer bodies. At this time cytogenetic analysis of bone marrow cells showed 46XX, t (15;17). The leukocyte count gradually decreased to 1,500/ul, and the dysplastic features disappeared. On March 21 her thrombocytes and reticulocytes began to increase, and she achieved complete remission when her abnormal karyotype disappeared on March 24. She suffered no severe complications such as infection or hemorrhage during treatment. We therefore suggest that ATRA is very effective for APL in elderly patients. It neither exacerbates DIC nor increases the risk of infection. In fact, when ATRA treatment is compared to the standard cytotoxic chemotherapy there is a reduced risk of infection.
Handa
H
H
Department of Internal Medicine, Saiseikai Maebashi Hospital.
Jinbo
T
T
Okamoto
K
K
Hirabayashi
H
H
Miyawaki
S
S
D000284:Administration, Oral; D000368:Aged; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications / Q000188:drug therapy*; D012074:Remission Induction; D014212:Tretinoin / Q000008:administration & dosage / Q000627:therapeutic use*
D014212:Tretinoin; D006493:Heparin