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Activity of all‐ trans ‐retinoic acid in a case of central nervous system extramedullary relapse of acute promyelocytic leukemia
Author(s) -
Patriarca Francesca,
Filì Carla,
Geromin Antonella,
Sperotto Alessandra,
Prosdocimo Simonetta,
Fanin Renato
Publication year - 2002
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1034/j.1600-0609.2002.01660.x
Subject(s) - acute promyelocytic leukemia , medicine , bone marrow , central nervous system , idarubicin , cerebrospinal fluid , retinoic acid , medullary cavity , magnetic resonance imaging , myeloid , pathology , myeloid leukemia , complete remission , chemotherapy , radiology , biology , biochemistry , gene
We describe a patient with an acute promyelocytic leukemia (APL) previously treated with two courses of cytarabin, idarubicin and all‐ trans retinoic acid (ATRA), who presented a medullary and meningeal relapse after 8 months of complete remission. A diagnosis of central nervous system (CNS) involvement was based on the appearance of APL blasts in the cerebrospinal fluid (CSF); magnetic resonance (MR) imaging was negative. The neurological symptoms were not evident at the time of recognition of the medullary recurrence, but appeared a few days later, when the patient had already received a reinduction treatment. When the CSF was first examined, showing atypical promyelocytes, there was no excess of blasts on bone‐marrow examination. The patient was treated with ATRA and intrathecal administrations of cytoxic drugs, achieving a complete long‐lasting CNS remission. The appearance of mature myeloid cells in the CSF during this treatment suggested a possible differentiating effect of ATRA towards extramedullary relapse.