Tretinoin in pregnancy complicated with acute promyelocytic leukaemia.
Acute promyelocytic leukemia (APL) in pregnancy poses serious danger to both the mother and fetus. Cytotoxic chemotherapy may cause teratogenicity to the fetus. APL is unique because it is usually associated with a coagulopathy that markedly increases the risk for the mother and fetus. A 21 year old lady with APL in her third trimester of pregnancy was treated with oral tretinoin. Tretinoin reversed the coagulopathy and normalised her blood counts without causing cytotoxic damage associated with cancer chemotherapy. Fetal distress occurred at 37 weeks of gestation and an emergency caesarean section was performed without complications and no blood transfusion support was needed as her coagulopathy and thrombocytopenia had resolved. A remission was achieved with only tretinoin induction. She subsequently had consolidation and maintenance chemotherapy. The mother and baby remain well at 4 years from completion of chemotherapy. A total of 10 pregnancies associated with APL have been reported in the current literature. Premature delivery and a fetal arrhythmia were the only complications. Although retinoin is considered teratogenic, its use so far in second and third trimester has been safe.
Department of Medicine, University Malaya, 50603 Kuala Lumpur.
K W
KW
Leong
A
A
Teh
J J
JJ
Bosco
D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006340:Heart Rate, Fetal / Q000187:drug effects; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications*; D008296:Malaysia; D011247:Pregnancy; D011248:Pregnancy Complications; D011263:Pregnancy Trimester, Third; D047928:Premature Birth; D014212:Tretinoin / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
D000970:Antineoplastic Agents; D014212:Tretinoin