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Acute promyelocytic leukemia and pregnancy
A A Giagounidis1, M W Beckmann, A S Giagounidis
1Clinic for Hematology, Oncology and Clinical Immunology, Heinrich-Heine-Universität, Düsseldorf, Germany. giagouni@uni-duesseldorf.de
European Journal of Haematology
|April 25, 2000
Summary
All-trans-retinoic acid (ATRA) effectively treats acute promyelocytic leukemia (APL) in pregnant patients. While teratogenic in early pregnancy, ATRA appears safe in later trimesters with careful monitoring for fetal cardiac effects.
Area of Science:
- Hematology
- Oncology
- Teratology
Background:
- Acute promyelocytic leukemia (APL) is a treatable hematologic malignancy.
- All-trans-retinoic acid (ATRA) is a standard differentiating agent for APL.
- ATRA poses a risk of teratogenicity, particularly in the first trimester of pregnancy.
Observation:
- A 23-year-old pregnant woman (21 weeks gestation) with APL was treated with ATRA and chemotherapy.
- The mother achieved complete remission.
- Fetal development was normal, and a healthy infant was delivered at 35 weeks gestation.
Findings:
- A literature review identified 14 APL pregnancies treated with ATRA.
- No malformations or teratogenic effects were observed in infants exposed to ATRA from the 3rd week of gestation onwards.
- Observed side effects included fetal cardiac arrhythmias and induced labor.
Implications:
- ATRA may be a safe and effective treatment option for APL during the second and third trimesters of pregnancy.
- Close obstetric surveillance for fetal cardiac complications is essential.
- Further research is warranted to fully elucidate the risk-benefit profile of ATRA in pregnancy.