title: Acute promyelocytic leukemia during pregnancy: a systematic analysis of outcome.
abstract: The outcomes of acute promyelocytic leukemia (APL) in pregnancy are largely unknown. The MEDLINE database was systematically searched to obtain 43 articles with 71 patients with new-onset APL during pregnancy. Induction therapy included various regimens of all-trans retinoic acid (ATRA), cytarabine, and anthracycline and resulted in a complete remission rate of 93%. Obstetric and fetal complications included pre-term deliveries (46%), spontaneous/therapeutic abortion/intrauterine death (33.3%) and other neonatal complications (25.9%). Mothers diagnosed in the first trimester were more likely to experience obstetric (p < 0.01) and fetal (p < 0.01) complications. To our knowledge, this is the largest systematic review of APL in pregnancy. The vast majority of APL patients in pregnancy may achieve remission with initial induction therapy. APL or its therapy in pregnancy, however, is associated with a high risk of fetal and obstetrical complications. The results of our study may help in patient counseling and informed decision-making.
authors.affiliation: a Department of Radiation Oncology , University of Nebraska Medical Center , Omaha , NE , USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Verma
authors.affiliation: b Department of Internal Medicine , University of Tennessee Health Science Center , Memphis , TN , USA.
authors.forename: Smith
authors.initials: S
authors.lastname: Giri
authors.affiliation: c Department of Medicine , University of Pittsburgh Medical Center - Mercy Hospital , Pittsburgh , PA , USA.
authors.forename: Samyak
authors.initials: S
authors.lastname: Manandhar
authors.affiliation: d Department of Internal Medicine , Reading Health System , West Reading , PA , USA.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Pathak
authors.affiliation: e Department of Internal Medicine , Division of Hematology/Oncology, University of Nebraska Medical Center , Omaha , NE , USA.
authors.forename: Vijaya Raj
authors.initials: VR
authors.lastname: Bhatt
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D060830:Consolidation Chemotherapy; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000175:diagnosis* / Q000188:drug therapy*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D011256:Pregnancy Outcome; D012074:Remission Induction; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014212:Tretinoin
keywords: Acute myeloid leukemia; acute promyelocytic leukemia; all-trans retinoic acid; anthracycline; pregnancy