tretinoin and Ecchymosis

We present a rather uncommon side effect observed in a 20-year-old man with acute promyelocytic leukemia during treatment with ATRA. He developed a high platelet counts reaching up to 1655×10⁹/L on day 29 of ATRA treatment, and started to recover spontaneously on day 33 of treatment, without any change in ATRA, or adding any cytoreduction therapy. No complications associated with thrombocytosis were observed. IL-6 seems to play an important role in the pathogenesis of the thrombocytosis induced by ATRA. However, it is unclear what are the precipitating factors for this rare phenomenon and whether it is caused by certain predisposing factors that might be related to patient's, disease pathogenesis or other unknown factors.

Topics: Bone Marrow; Ecchymosis; Humans; Interleukin-6; Leukemia, Promyelocytic, Acute; Male; Thrombocytosis; Tretinoin; Young Adult

Acute promyelocytic leukemia (APL) is one of the most curable cancers. However, relapse of the disease is a difficult issue in clinical practice and it remains a great challenge that patients have a poor effect of conventional treatment in the clinic. Therefore, new and more effective therapeutic measures are urgently needed. Herein, we report a case of relapsed and refractory APL harboring a RARA-LBD region mutation successfully treated with venetoclax (VEN).. A 37-years-old woman was admitted to our hospital with worsening spontaneous gingival bleeding and skin ecchymosis. Physical examination revealed multiple petechiae and ecchymosis in the extremities.. The patient was diagnosed with L-type PML-RARα-positive APL, harboring a RARA-LBD region mutation, low-risk, based on bone marrow cytology, immunophenotypic analysis by flow cytometry, karyotype analysis, and molecular analysis.. Complete remission was achieved after the first induction therapy of all-trans retinoic acid (ATRA) combined with arsenic trioxide, but relapse was observed only after 11 months. Reinduction with ATRA and arsenic trioxide combined with anthracycline failed. Therefore, we tried to provide a new treatment with the Bcl-2 inhibitor VEN orally (100 mg d1, 200 mg d2 to d18, followed by 300 mg daily continuously).. Clinical symptoms and laboratory indicators improved rapidly with VEN treatment. A complete hematologic response was achieved with VEN-based therapy.. Related drug resistance gene monitoring should be performed canonically in relapsed and refractory APL. Some relapsed and refractory APL that failed to respond to conventional treatment were at risk of death. Bcl-2 inhibitors are expected to be an effective salvage therapy for patients with resistance to ATRA, which is worthy of further discussion.

Topics: Adult; Antineoplastic Agents; Arsenic Trioxide; Bridged Bicyclo Compounds, Heterocyclic; Ecchymosis; Female; Humans; Leukemia, Promyelocytic, Acute; Mutation; Proto-Oncogene Proteins c-bcl-2; Recurrence; Salvage Therapy; Sulfonamides; Treatment Outcome; Tretinoin

Topics: Adult; Ecchymosis; Epistaxis; Hematologic Tests; Humans; Leukemia, Promyelocytic, Acute; Leukocyte Count; Male; Tretinoin

Topics: Antineoplastic Agents; Diagnosis, Differential; DNA, Neoplasm; Ecchymosis; Humans; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Tretinoin