The thrombophilic state in acute promyelocytic leukemia

Acute promyelocytic leukemia is characterized by the association with a severe coagulopathy resulting in hemorrhagic manifestations. The pathogenesis underlying the hemorrhagic syndrome is complex and involves the activation of the coagulation cascade and the fibrinolytic system. All-trans-retinoic acid (ATRA) appears to correct both procoagulant and fibrinolytic activities in vitro and in vivo. Early results of treatment with arsenic trioxide, which acts by inducing apoptosis of the leukemic promyelocytes, also show regression in the coagulopathy with a decrease in fibrin degradation products and D-Dimer. A clear understanding of the relationship between laboratory changes and the effects of ATRA and arsenic trioxide requires further studies.