Acute promyelocytic leukemia during pregnancy: report of 3 cases.
Acute promyelocytic leukemia (APL) is characterized by onset at a young age and a life-threatening hemorrhagic diathesis, which is attributed to a disseminated intravascular coagulation (DIC)-like coagulopathy. The discovery of all-trans-retinoic acid has changed the course of APL treatment by reducing the onset of DIC and inducing a complete and durable remission in more than 90% of patients. The occurrence of APL during pregnancy is not a frequent event, but the management of these patients raises many therapeutic and ethical dilemmas and requires a careful clinical case evaluation of fetal and maternal risk, coagulation status, the parents' wishes, and therapeutic options. Here we describe 3 patients with APL diagnosed during pregnancy. Clinical data and the therapeutic approaches are presented. In the discussion, we analyze clinical decisions and therapeutic options and compare our cases with those found in the literature.
Consoli
Ugo
U
Chair and Division of Haematology with Bone Marrow Transplantation Unit, University of Catania, Catania, Italy. ugo.consoli@tin.it
Figuera
Amalia
A
Milone
Giuseppe
G
Meli
Carmela Rita
CR
Guido
Giulia
G
Indelicato
Francesco
F
Moschetti
Gaetano
G
Leotta
Salvatore
S
Tornello
Antonella
A
Poidomani
Massimo
M
Murgano
Pamela
P
Pinto
Valeria
V
Giustolisi
Rosario
R
D000014:Abnormalities, Drug-Induced / Q000517:prevention & control; D000032:Abortion, Therapeutic; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019090:Case Management; D002585:Cesarean Section; D017809:Fatal Outcome; D005260:Female; D005865:Gestational Age; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D007231:Infant, Newborn; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis / Q000628:therapy; D008297:Male; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000628:therapy; D012074:Remission Induction; D012306:Risk; D012449:Safety; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D000970:Antineoplastic Agents; D014212:Tretinoin; D015255:Idarubicin