Successful treatment of acute promyelocytic leukemia complicated by liver cirrhosis with all-trans retinoic acid and reduced-dose anthracycline chemotherapy

Abstract

Although all-trans retinoic acids (ATRA) are most commonly used as agents in acute promyelocytic leukemia (APL), there are few reports on the administration of ATRAs to patients with liver insufficiency. We report two cases of APL; a 57-year-old man with APL complicated by liver cirrhosis (Child-Pugh class B) and hepatocellular carcinoma who is receiving transcatheter arterial chemoembolization (TACE) and a 50-year-old man with APL complicated by liver cirrhosis (Child-Pugh class B) who is being prepared for receiving a living-donor liver transplantation. Both patients were successfully treated with a normal dosage of ATRA alone during remission-induction therapy. Because the total bilirubin and hepatic transaminases in the two cases were almost at normal levels; the patients received three courses of ATRAs plus a 42%-70% dose of anthracyclines as a consolidation therapy. At 1 year after receiving intermittent ATRA therapy, the patients are maintaining molecular remission. These cases suggest that the administration of ATRA and modifications of doses of chemotherapeutic agents are applicable to APL patients with liver dysfunction.