tretinoin and Gestational-Trophoblastic-Disease

We report two cases of secondary acute promyelocytic leukemia (APL). One patient presented with concurrent APL and missed abortion 1 year after etoposide-based chemotherapy for gestational trophoblastic disease. A prolonged complete remission was achieved with standard chemotherapy. An elderly man developed APL 1 year after alkylator-based chemotherapy for mantle cell lymphoma (MCL). A complete clinical and molecular remission was obtained with chemotherapy and all- trans retinoic acid, followed by arsenic consolidation. Concomitant molecular relapse of APL and MCL clones was detected at 1 year, both of which responded to oral arsenic therapy. High-dose epipodophyllin is a dose risk for secondary APL, but alkylating agents may also be implicated. For patients with a history of active malignancy and heavy previous chemotherapy exposure, the use of nontoxic arsenic therapy appeared to be effective and prudent.

Topics: Adult; Aged; Antineoplastic Agents, Alkylating; Arsenic Trioxide; Arsenicals; Etoposide; Female; Gestational Trophoblastic Disease; Humans; Leukemia, Promyelocytic, Acute; Lymphoma, Mantle-Cell; Male; Neoplasms, Second Primary; Oxides; Pregnancy; Tretinoin