tretinoin and Nutrition-Disorders

Vitamin A and its newly developed synthetic analogues recently have been demonstrated to have profound effects on disorders of keratinization, sebaceous gland function, and cancer. In separate sections of this article, we review the history, chemistry, metabolism, mechanism of action, toxicity, and clinical applications of both the naturally occurring and synthetic retinoids.

Topics: Antineoplastic Agents; Carrier Proteins; Cell Membrane; Chemical Phenomena; Chemistry; Cytosol; Humans; Nutrition Disorders; Reproduction; Retinol-Binding Proteins; Skin; Skin Diseases; Tretinoin; Vision, Ocular; Vitamin A

A case is reported of a pregnant 16-year-old-woman diagnosed with Acute promyelocytic leukaemia (APL) at 25 weeks gestation and treated with all-trans retinoic acid (ATRA) (45 mg/m2) for 25 days in combination with chemotherapy. She achieved a complete cytogenetic and molecular remission. Clinical course was complicated, with an intracerebral bleed, respiratory failure requiring ventilation and prolonged pancytopenia following initial chemotherapy. A live female infant was born at 28 weeks gestation who survived to discharge with significant pulmonary complications. She remains oxygen dependent at 6 months of age. ATRA has been used from the 3rd week of gestation, but fetal malformations are common during the first trimester. In contrast it seems to be safe in the second and third trimesters with regard to teratogenesis but can cause other side-effects. Most successful outcomes in treatment of APL during pregnancy are seen after treatment with ATRA and delivery of the baby at as late a stage as possible. Pregnancies terminated before remission has been obtained or those treated in the first trimester have a poor maternal outcome.

Topics: Adolescent; Anticonvulsants; Antineoplastic Combined Chemotherapy Protocols; Cerebral Hemorrhage; Cesarean Section; Dexamethasone; Diuretics; Epilepsy, Tonic-Clonic; Female; Fetal Growth Retardation; Humans; Idarubicin; Infant, Newborn; Leukemia, Promyelocytic, Acute; Lung; Neutropenia; Nutrition Disorders; Oxygen; Parenteral Nutrition, Total; Pregnancy; Pregnancy Complications; Pregnancy Complications, Neoplastic; Remission Induction; Respiration Disorders; Tranexamic Acid; Tretinoin