Abstract
The management of pregnant women with acute promyelocytic leukemia (APL) is a challenging situation where limited evidence-based information is available. We performed a systematic literature review to analyze the outcomes reported for both mother and fetus when APL is diagnosed during pregnancy. PubMed, Scopus and Web of Science databases were systematically searched to identify studies reporting cases of APL during pregnancy. Sixty-six articles met the eligibility criteria (53 single case reports). Ninety-two patients were eligible for induction therapy, with most them being treated with all-trans retinoic acid alone (32%) or combined with chemotherapy (43%), while the remaining patients received chemotherapy alone. Three patients were treated with arsenic-based regimens after delivery. Overall complete remission rate was 89%, with no statistically significant differences according to the type of induction and gestational age. During the first trimester, women were more likely to experience spontaneous and induced abortion compared to those during the second trimester (88% vs. 30%) (p < 0.0001), while only one patient diagnosed during the third trimester terminated in stillbirth. Twelve of 16 infants with neonatal complications had respiratory distress syndrome. Except two early deaths (Potter’s syndrome and pulmonary hemorrhage), all neonates evolved favorably. This study confirms that gestational age does not affect the results in the mother, but is closely related to fetal viability. Our results may be useful for the process of decision making that requires the involvement of the patient, hematologist, obstetrician and neonatologist.
Highlights
Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) with unique molecular pathogenesis, clinical manifestations and treatment. It is characterized by a balanced translocation t(15;17) (q24;q21) that generates the PML-RARA fusion gene. This hybrid gene confers a particular sensitivity to treatment with anthracycline-based chemotherapy and differentiating agents, such as all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO), converting this once fatal leukemia into a highly curable disease [1]
The search was restricted to articles with at least an informative abstract in English using preset search criteria across PubMed, Scopus and Web of Science databases from inceptions to using the search terms “acute promyelocytic leukemia” or “acute myeloid leukemia” or “acute
This study shows that, despite the diagnosis of APL in a pregnant woman is a challenging situation, the chances of achieving complete remission (CR) for the mother remain very high, regardless of gestational age at diagnosis
Summary
Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) with unique molecular pathogenesis, clinical manifestations and treatment It is characterized by a balanced translocation t(15;17) (q24;q21) that generates the PML-RARA fusion gene. Cancers 2020, 12, 968 age, choice of the most suitable therapeutic approach and attitude of the patient towards the increased maternal and fetal risk, sometimes including ethical/moral considerations. Fetal outcomes in pregnant women with APL is limited only one figures patients) to publications that mostly include a single patient and a few with 2 to 4 patients [2,3], to with only one. Clinical outcomes reported for both the mother and the fetus in different scenarios, with particular aimuse of this study istherapies to complete a comprehensive systematic literature review to analyze the focusThe on the of modern according to gestational age
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