Successful treatment of acute promyelocytic leukaemia during pregnancy.
A case is reported of a pregnant 16-year-old-woman diagnosed with Acute promyelocytic leukaemia (APL) at 25 weeks gestation and treated with all-trans retinoic acid (ATRA) (45 mg/m2) for 25 days in combination with chemotherapy. She achieved a complete cytogenetic and molecular remission. Clinical course was complicated, with an intracerebral bleed, respiratory failure requiring ventilation and prolonged pancytopenia following initial chemotherapy. A live female infant was born at 28 weeks gestation who survived to discharge with significant pulmonary complications. She remains oxygen dependent at 6 months of age. ATRA has been used from the 3rd week of gestation, but fetal malformations are common during the first trimester. In contrast it seems to be safe in the second and third trimesters with regard to teratogenesis but can cause other side-effects. Most successful outcomes in treatment of APL during pregnancy are seen after treatment with ATRA and delivery of the baby at as late a stage as possible. Pregnancies terminated before remission has been obtained or those treated in the first trimester have a poor maternal outcome.
D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000188:drug therapy / Q000209:etiology; D002585:Cesarean Section; D003907:Dexamethasone / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004830:Epilepsy, Tonic-Clonic / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D007231:Infant, Newborn; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications / Q000188:drug therapy*; D008168:Lung / Q000002:abnormalities; D009503:Neutropenia / Q000139:chemically induced; D009748:Nutrition Disorders / Q000209:etiology / Q000628:therapy; D010100:Oxygen / Q000627:therapeutic use; D010289:Parenteral Nutrition, Total; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000628:therapy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy*; D012074:Remission Induction; D012120:Respiration Disorders / Q000151:congenital / Q000209:etiology; D014148:Tranexamic Acid / Q000627:therapeutic use; D014212:Tretinoin / Q000008:administration & dosage
D000927:Anticonvulsants; D004232:Diuretics; D014212:Tretinoin; D014148:Tranexamic Acid; D003907:Dexamethasone; D010100:Oxygen; D015255:Idarubicin