[Acute promyelocytic leukemia relapse as leukemia cutis shortly after complete remission with all-trans retinoic acid].
A 56-year-old man was admitted to our hospital in September, 1996. Chromosomal translocation (15; 17) and a PT-PCR study for PML-RAR alpha mRNA were positive in bone marrow aspirates, and acute promyelocytic leukemia was diagnosed. After CR was obtained with all-trans retinoic acid (ATRA) followed up with chemotherapy, the RT-PCR became negative. When he was readmitted in April, 1997, skin eruption on his chest and extremities were observed. Specimens taken for biopsy revealed leukemia cutis, and RT-PCR became positive in the same specimen. Bone marrow PT-PCR was also positive without abnormal promyelocytes. Although he was treated with oral ATRA 80 mg/day again, no significant improvement in leukemia cutis was noted. After combined therapy with Ara-C and acularubicin, skin eruption disappeared and bone marrow RT-PCR became negative. A second CR was then obtained. Although it is unknown whether the administration of ATRA is related to extramedullary relapse or not, we recommend combined chemotherapy for such cases.
Itoh
K
K
First Department of Internal Medicine, Saitama Medical School.
Gotoh
W
W
Yagasaki
F
F
Itoh
Y
Y
Kawai
N
N
Matsuda
A
A
Tominaga
K
K
Kusumoto
S
S
Ino
H
H
Murohashi
I
I
Jinnai
I
I
Takeuchi
H
H
Bessho
M
M
Hirashima
K
K
D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000473:pathology*; D017254:Leukemic Infiltration / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D012867:Skin / Q000473:pathology*; D014212:Tretinoin / Q000627:therapeutic use*
D014212:Tretinoin