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Use of all-trans retinoic acid in the treatment of acute promyelocytic
leukemia
ME Huang, YC Ye, SR Chen, JR Chai, JX Lu, L Zhoa, LJ Gu and ZY Wang
Shanghai Institute of Hematology, Shanghai Second Medical University,
People's Republic of China.
Twenty-four patients with acute promyelocytic leukemia (APL) were treated
with all-trans retinoic acid (45 to 100 mg/m2/day). Of these, eight cases
had been either nonresponsive or resistant to previous chemotherapy; the
other 16 cases were previously untreated. All patients attained complete
remission without developing bone marrow hypoplasia. Bone marrow suspension
cultures were studied in 15 of the 24 patients. Fourteen of these patients
had morphological maturation in response to the retinoic acid (1 mumol/L).
Chloroacetate esterase and alpha-naphthyl acetate esterase staining as well
as electronmicroscopic examination confirmed that retinoic acid-induced
cells differentiated to granulocytes with increased functional maturation
(as measured by nitroblue tetrazolium reduction, NBT). The single
nonresponder to retinoic acid in vitro was resistant to treatment with
retinoic acid but attained complete remission after addition of low-dose
cytosine arabinoside (ara-C). During the course of therapy, none of the
patients showed any abnormalities in the coagulation parameters we
measured, suggesting an absence of any subclinical disseminated
intravascular coagulation. The only side effects consisted of mild dryness
of the lips and skin, with occasional headaches and digestive symptoms.
Eight patients have relapsed after 2 to 5 months of complete remission. The
others remain in complete remission at 1+ to 11+ months and are still being
followed up. We conclude that all-trans retinoic acid is an effective
inducer for attaining complete remission in APL.
Volume 72,
Issue 2,
pp. 567-572,
08/01/1988
Copyright © 1988 by The American Society of Hematology
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