Acute Promyelocytic Leukemia during Pregnancy: A Systematic Review of the Literature

Abstract

The management of pregnant women with acute promyelocytic leukemia (APL) is a challenging situation where limited evidence-based information is available. We performed a systematic literature review to analyze the outcomes reported for both mother and fetus when APL is diagnosed during pregnancy. PubMed, Scopus and Web of Science databases were systematically searched to identify studies reporting cases of APL during pregnancy. Sixty-six articles met the eligibility criteria (53 single case reports). Ninety-two patients were eligible for induction therapy, with most them being treated with all-trans retinoic acid alone (32%) or combined with chemotherapy (43%), while the remaining patients received chemotherapy alone. Three patients were treated with arsenic-based regimens after delivery. Overall complete remission rate was 89%, with no statistically significant differences according to the type of induction and gestational age. During the first trimester, women were more likely to experience spontaneous and induced abortion compared to those during the second trimester (88% vs. 30%) (p < 0.0001), while only one patient diagnosed during the third trimester terminated in stillbirth. Twelve of 16 infants with neonatal complications had respiratory distress syndrome. Except two early deaths (Potter’s syndrome and pulmonary hemorrhage), all neonates evolved favorably. This study confirms that gestational age does not affect the results in the mother, but is closely related to fetal viability. Our results may be useful for the process of decision making that requires the involvement of the patient, hematologist, obstetrician and neonatologist.

Pregnant woman with acute promyelocytic leukemia delivers healthy twins and is cured successfully: A case report

“…Pregnancy associated with APL is extremely rare and makes its management more difficult (4)(5)(6). APL and its treatment during pregnancy may lead to maternal complications, such as coagulopathy and abortions, as well as fetal complications, such as preterm birth and intrauterine growth restriction (3). The current study reported the case of a young patient delivering two healthy infants while undergoing treatment for APL.…”

“…Although contemporary combined ATRA and ATO therapy is effective in inducing complete remission (CR) in the majority of patients, the use of this regimen remains controversial in pregnant women. ATO has a significant transplacental transport and is highly embryotoxic (2,3). Therefore, its use in pregnancy is not recommended.…”

Cancer Treatment and Immunotherapy during Pregnancy

“…Treating pregnant women with acute promyelocytic leukemia (APL) is an extremely difficult situation, where there is limited evidence. The studies found in the literature are limited, and usually concern only a few series of patients [ 66 ].…”

Acute promyelocytic leukemia: from genetic lesions identification to molecularly targeted therapy

“…If the result of the second test is negative, it is recommended to monitor the presence of MRD every 3 months for 2 years. The test should be carried out in the same laboratory to ensure the same level of sensitivity [85]. MRD monitoring with NGS enables the examination of not only specific transcripts, but also potentially other RARA fusion transcripts [76].…”