A Complicated Case of Acute Promyelocytic Leukemia in the Second Trimester of Pregnancy Successfully Treated with All-<i>trans</i>-Retinoic Acid

Agarwal, Kanika; Patel, M.; Agarwal, Vandana

doi:10.1155/2015/634252

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…[4] Coagulation abnormalities, disseminated intravascular coagulation, placental abnormalities, premature delivery, and obstetric complications may be observed at presentation or during the course of disease. [5][6][7] Urgent and competent management with ATRA may ameliorate coagulation parameters and bleeding, as in our patient.…”

Section: Discussionsupporting

confidence: 52%

Acute Promyelocytic Leukemia Diagnosed at the End of First Trimester with a Successful Outcome

Baysal

Ümit

Ozdover

et al. 2018

EJMO

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The treatment and management of patients with acute promyelocytic leukemia (APL) diagnosed in pregnancy can involve a wide range of difficulties and limitations. Thus, these cases are each unique and present challenges to physicians. The aim of this study was to present the case of a 24-year-old patient who was diagnosed with APL in the 14th week of pregnancy who was treated successfully with all-trans retinoic acid and chemotherapy.

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Section: Discussionsupporting

confidence: 52%

Acute Promyelocytic Leukemia Diagnosed at the End of First Trimester with a Successful Outcome

Baysal

Ümit

Ozdover

et al. 2018

EJMO

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“…In our case, there was no teratogenic risk since the treatment began after the organogenesis period (4-10 WG). Many cases of pregnancies with ATRA during the second and third trimesters are reported in the literature with no serious adverse outcomes [6,[9][10][11].…”

Section: Resultsmentioning

confidence: 99%

Arsenic Trioxide Treatment during Pregnancy for Acute Promyelocytic Leukemia in a 22-Year-Old Woman

Simonet

Cattin

et al. 2020

Case Reports in Hematology

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Acute leukemia during pregnancy is rare (1 for 100000 pregnancies). The association of arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) is known as the best therapy in standard-risk acute promyelocytic leukemia (APL). We describe the first case of a pregnancy with ATRA and ATO reported in the literature. In March 2018 at the University Hospital of Besançon, a 22-year-old woman was diagnosed with APL at 14 weeks of gestation (WG). She received a total of 2160 mg of ATRA and 930 mg of ATO between 14 and 35 WG. The mother’s cytological remission was very fast. No maternal or fetal complications occurred during pregnancy. The pediatrics outcomes were good. Many case reports about ATRA exposure during the second and third trimesters report no serious adverse effect for pregnancy. ATO is teratogenic, genotoxic, and carcinogenic and passes through the placenta. Fetal exposure seems to be associated with bad pregnancy outcomes (preterm delivery, decreased birth weight, and fetal loss) and with lung diseases in young adults. No clinical trial is obviously possible, and the only data available are environmental exposure or animal studies. This case report may help medical teams to make hard decision for a treatment of APL during pregnancy.

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“…Despite the guarded prognosis, prompt ICU admission and the multidisciplinary team approach positively impacted the overall patient outcome. Some but not all reviewed cases reported mild differentiation syndrome [ 8 , 12 , 13 ]. In Santolaria’s review, the causes of death were reported in 7 patients (out of a total of 10 deaths): 3 intracranial hemorrhages, 3 cases of multiorgan failure (2 caused by severe differentiation syndrome), and 1 caused by infection [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Promyelocytic Leukemia and Severe Differentiation Syndrome in Pregnancy—A Management Challenge

Droc

Stancioaica

Soare

et al. 2023

Life

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Acute promyelocytic leukemia (APL) is generated by the PML-RARA fusion gene. In patients suffering from APL, the early diagnosis and treatment are essential in the successful management. We reported a case of a 27-year-old 17th-week pregnant patient diagnosed with APL. After an extensive hematological diagnostic panel, the acute promyelocytic leukemia was confirmed, and the patient received all-trans retinoic acid (ATRA), idarubicin (IDA), and dexamethasone, following national guidelines. Due to ATRA-related differentiation syndrome, the therapy was adjusted, and hydroxycarbamide was added with a good outcome. The patient was admitted to the ICU secondary to hypoxemic respiratory failure on the 2nd day after hospital admission. Our patient received an individualized drug combination, adjusted by the clinical response. Furthermore, the drugs used in APL treatment are all teratogenic. Despite various major complications, including severe acute respiratory distress syndrome (ARDS), which needed mechanical ventilation; ICU-acquired myopathy; and spontaneous abortion, the patient had a good outcome and was transferred from the ICU after a total stay of 40 days. APL during pregnancy is a rare entity of intermediate-risk APL. Our study emphasized the need for individualized therapy in a rare case of a pregnant woman diagnosed with a potentially fatal hematologic disease.

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A Complicated Case of Acute Promyelocytic Leukemia in the Second Trimester of Pregnancy Successfully Treated with All-trans-Retinoic Acid

Cited by 7 publications

References 22 publications

Acute Promyelocytic Leukemia Diagnosed at the End of First Trimester with a Successful Outcome

Acute Promyelocytic Leukemia Diagnosed at the End of First Trimester with a Successful Outcome

Arsenic Trioxide Treatment during Pregnancy for Acute Promyelocytic Leukemia in a 22-Year-Old Woman

Acute Promyelocytic Leukemia and Severe Differentiation Syndrome in Pregnancy—A Management Challenge

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