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A clinical and experimental study on all-trans retinoic acid-treated acute
promyelocytic leukemia patients
ZX Chen, YQ Xue, R Zhang, RF Tao, XM Xia, C Li, W Wang, WY Zu, XZ Yao and BJ Ling
Hematology Department, First Affiliated Hospital, Suzhou Medical College,
Jiangsu, People's Republic of China.
Fifty patients with acute promyelocytic leukemia (APL) have been treated
with all-trans retinoic acid (RA). In vitro induced differentiation of
primarily cultured bone marrow cells from the patients, colony-forming unit
granulocyte-macrophage (CFU-GM) and L-CFU colony-forming assays, and
karyotype analysis were performed over the treatment course. The very high
bone marrow complete remission (CR) rate (94%) suggested that all-trans RA
was superior to conventional chemotherapeutic regimens for the treatment of
APL. The leukemic clone was reduced by RA-induced terminal differentiation
and loss of proliferation capacity of leukemic cells. Relapse after CR in
about 40% of patients was the major reason for the failure of the RA
treatment. Patients who relapsed after a chemotherapy-maintained CR could
be effectively reinduced to second CR by RA. However, if relapse occurred
after a CR maintained by both RA and chemotherapy, the sensitivity of newly
emerged leukemic clones to RA was greatly reduced. Therefore, it is
suggested that RA should be replaced by conventional chemotherapy as soon
as CR is achieved. Laboratory studies proved valuable in selecting cases
for RA therapy and in predicting therapeutic effects and prognosis.
Volume 78,
Issue 6,
pp. 1413-1419,
09/15/1991
Copyright © 1991 by The American Society of Hematology
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