Abstract
Three patients, aged 1, 10, and 12 years old, with acute promyelocytic leukemia (APL) received induction, consolidation, and maintenance chemotherapy combined with all-trans retinoic acid (ATRA). They all achieved complete remission on days 27, 34, and 40, respectively, from induction therapy. PML-RARα fusion mRNA in bone marrow cells turned to an undetectable level by the third consolidation. One patient underwent autologous peripheral blood stem cell transplantation (auto-PBSCT) after two courses of consolidation with ATRA, and the remaining two received intermittent maintenance therapy containing ATRA for a year after six courses of consolidation with ATRA. All patients maintained complete remission for 27, 31, and 53 months, respectively. During the induction therapy with ATRA, retinoic acid (RA) syndrome occurred in one case. This case also developed interstitial pneumonia after auto-PBSCT. A cough and an interstitial shadow in the chest roentgenogram remained for several years. These pulmonary diseases might be caused not only by irreversible histological change in the respiratory tract as a sequel of RA syndrome, but also by busulfan used for the preconditioning of PBSCT. Although ATRA is an effective antileukemic agent for APL, there are few reports of childhood cases treated with ATRA for both consolidation and maintenance therapy. Furthermore, randomized studies are needed to assess its usefulness in the treatment of APL in childhood.
