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Treatment of acute promyelocytic leukaemia relapsing after allogeneic bone marrow transplantation with all‐ trans ‐retinoic acid: suppression of the leukaemic clone
Author(s) -
Bashford John,
Szer Jeff,
Wiley James S.,
Buckley Michael,
Garson O. Margaret,
Van der Weyden Martin B.
Publication year - 1991
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1991.tb04542.x
Subject(s) - pancytopenia , clone (java method) , bone marrow , medicine , retinoic acid , tretinoin , transplantation , acute promyelocytic leukemia , myeloid , cancer research , immunology , gastroenterology , pathology , biology , cell culture , genetics , dna
Summary We describe the clinical experience of a male patient with acute promyelocytic leukaemia, relapsing after sex‐mismatched allogeneic bone marrow transplantation and treated with all‐ trans ‐retinoic acid. Resolution of the coagulopathy was observed by day 7 of therapy. A complete remission was achieved by day 47 after a period of pancytopenia, dysplastic myeloid maturation and bone marrow hypo‐cellularity with necrosis and fibrosis. Serial cytogenetic analyses revealed a progressive loss of the male leukaemic clone [46XY, t(15;17)] and emergence of normal female (donor) cells [46XX] which became completely dominant with remission. Adverse effects of all‐ trans ‐retinoic acid included bone pain and a prominent leucocytosis requiring leukaphereses and hydroxyurea therapy. All‐ trans ‐retinoic acid can induce complete remission of recurrent acute promyelocytic leukaemia following bone marrow transplantation. The data suggest that remission is due to differentiation and suppression of the leukaemic clone while allowing repopulation of the marrow with non‐malignant cells.