Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Jun;10(3):153-156.
doi: 10.14740/wjon1211. Epub 2019 Jun 29.

Acute Myeloid Leukemia Acquiring Promyelocytic Leukemia-Retinoic Acid Receptor Alpha at Relapse

Varsha Gupta  1 , Mohammed Shariff  1 , Ravneet Bajwa  1 , Ishan Patel  1 , Hashem A Ayyad  2 , Michael J Levitt  1 , Peter J Mencel  1 , Mohammad A Hossain  1
Affiliations
Case Reports

Acute Myeloid Leukemia Acquiring Promyelocytic Leukemia-Retinoic Acid Receptor Alpha at Relapse

Varsha Gupta et al. World J Oncol. 2019 Jun.

Abstract

Acute promyelocytic leukemia (APL) is identified as the M3 subtype of acute myeloid leukemia (AML). APL is presently one of the most curable leukemias. We describe here a rare case of APL who presented as a relapsed disease after 1 year of chemotherapy for AML. The patient lacked t(15;17) at the initial presentation but was present later at the time of relapse. The patient attained a complete remission following treatment with all-trans retinoic acid (ATRA) and arsenic trioxide-based therapy. We discuss the possible mechanism behind secondary acquisition of promyelocytic leukemia/retinoic acid receptor alpha (PML-RARA) at relapse of AML. We also briefly discuss the clinical features, diagnosis and treatment of APL.

Keywords: Acute myeloid leukemia; Acute promyelocytic leukemia; All-trans retinoic acid.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
Bone marrow biopsy showing hypocellular marrow for age (× 100).
Figure 2
Figure 2
Bone marrow biopsy showing infiltration of marrow by monomorphic cells with fine chromatin and moderate amounts of granular cytoplasm (× 400).
Figure 3
Figure 3
Bone marrow biopsy. Promyelocyte (blast equivalent) showing Auer rods and cytoplasmic coarse granules and fine chromatin (oil, × 1,000).
Figure 4
Figure 4
Bone marrow biopsy. Promyelocyte with Auer rod marked with black arrow.
Figure 5
Figure 5
Flow cytometry. The blasts show high side scatter indicating complex cytoplasm.
Figure 6
Figure 6
Flow cytometry. The blasts are positive for CD117 and negative for CD34 and HLA-DR, highly suggestive of APL.
See this image and copyright information in PMC

References

    1. Bernard J. History of promyelocytic leukaemia. Leukemia. 1994;8(Suppl 2):S1–5. - PubMed
    1. Coombs CC, Tavakkoli M, Tallman MS. Acute promyelocytic leukemia: where did we start, where are we now, and the future. Blood Cancer J. 2015;5:e304. doi: 10.1038/bcj.2015.25. - DOI - PMC - PubMed
    1. Shen ZX, Chen GQ, Ni JH, Li XS, Xiong SM, Qiu QY, Zhu J. et al. Use of arsenic trioxide (As2O3) in the treatment of acute promyelocytic leukemia (APL): II. Clinical efficacy and pharmacokinetics in relapsed patients. Blood. 1997;89(9):3354–3360. - PubMed
    1. De Braekeleer E, Douet-Guilbert N, De Braekeleer M. RARA fusion genes in acute promyelocytic leukemia: a review. Expert Rev Hematol. 2014;7(3):347–357. doi: 10.1586/17474086.2014.903794. - DOI - PubMed
    1. Vitale C, Jabbour E, Lu X, Yabe M, Kanagal Shamanna R, Daver N, Pemmaraju N. et al. Acute promyelocytic leukemia presented as a relapse of acute myeloid leukemia. Am J Hematol. 2016;91(4):E274–276. doi: 10.1002/ajh.24302. - DOI - PubMed

Publication types

LinkOut - more resources