A RELAPSED ACUTE PROMYELOCYTIC LEUKEMIA TREATED WITH ARSENIC TRIOXIDE ALONE: CASE REPORT

Abstract

Acute promyelocytic leukemia is now the most curable subtype of acute myeloid leukemia in adult .It is characterized by 3 main features which are the presence of abnormal promyelocyte in bone marrow, the occurrence of disseminated intravascular coagulopathy and the presence of classical chromosomal translocation {t(15:17)(q22:q21)} or its variant.The incorporation of ATRA in the induction over the past 25 years represents one of the most important advances in treatment of AML by inducing more differentiation of leukemic cells into mature granulocytes giving higher complete remission rate and resolution of the life threatening coagulopathy as well as decreases the relapse rate in comparison with chemotherapy alone. In 1990’s, investigators from China reported that arsenic trioxide (ATO) induces complete remission (CR) in patients with relapsed or refractory APL in 90% of cases by inducing partial differentiation & apoptosis of leukemic cells.In Al-Kadhimiya Teaching Hospital, we faced such a case of APL who relapsed for second time within 1 year duration of a previously achieved remission, and fortunately we treat the patient with ATO alone that induced CR within 1.5 month duration of treatment then followed by consolidation courses and maintenance treatment to strengthen this remission state that is still existing.Keywords: myeloid leukemia, acute promyelocytic leukemia, M3 subtype, relapse, all-transretinoic acid, and arsenic trioxide.