Activity of all-trans-retinoic acid in a case of central nervous system extramedullary relapse of acute promyelocytic leukemia.
We describe a patient with an acute promyelocytic leukemia (APL) previously treated with two courses of cytarabin, idarubicin and all-trans retinoic acid (ATRA), who presented a medullary and meningeal relapse after 8 months of complete remission. A diagnosis of central nervous system (CNS) involvement was based on the appearance of APL blasts in the cerebrospinal fluid (CSF); magnetic resonance (MR) imaging was negative. The neurological symptoms were not evident at the time of recognition of the medullary recurrence, but appeared a few days later, when the patient had already received a reinduction treatment. When the CSF was first examined, showing atypical promyelocytes, there was no excess of blasts on bone-marrow examination. The patient was treated with ATRA and intrathecal administrations of cytoxic drugs, achieving a complete long-lasting CNS remission. The appearance of mature myeloid cells in the CSF during this treatment suggested a possible differentiating effect of ATRA towards extramedullary relapse.
Patriarca
Francesca
F
Division of Hematology, Department of Bone Marrow Transplantation, Udine University Hospital, P. le S. Maria della Misericordia, I-13300 Udine, Italy. ematologia@dmm.uniud.it
Filì
Carla
C
Geromin
Antonella
A
Sperotto
Alessandra
A
Prosdocimo
Simonetta
S
Fanin
Renato
R
D002454:Cell Differentiation / Q000187:drug effects; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000166:cytology; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D022423:Myeloid Cells; D012008:Recurrence; D014212:Tretinoin / Q000008:administration & dosage* / Q000494:pharmacology
D014212:Tretinoin