Low-dose All-trans Retinoic Acid for Remission Induction of Acute Promyelocytic Leukemia in Acute Renal Failure

Hye Won Park; Ju Hyun Choi; Danbi Lee; Dong Hoe Koo; Ja Eun Koo; Sai Hui Kim; Je Hwan Lee; Jung Hee Lee; Kyoo Hyung Lee

doi:10.5045/kjh.2006.41.2.105

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Park, Choi, Lee, Koo, Koo, Kim, Lee, Lee, and Lee: Low-dose All-trans Retinoic Acid for Remission Induction of Acute Promyelocytic Leukemia in Acute Renal Failure

Original Article

Korean J Hematol 2006;41(2):105-109.

Published online: 19 June 2006

DOI: https://doi.org/10.5045/kjh.2006.41.2.105

Low-dose All-trans Retinoic Acid for Remission Induction of Acute Promyelocytic Leukemia in Acute Renal Failure

Hye Won Park, M.D., Ju Hyun Choi, M.D., Danbi Lee, M.D., Dong Hoe Koo, M.D., Ja Eun Koo, M.D., Sai Hui Kim, M.D., Je Hwan Lee, M.D., Jung Hee Lee, M.D., Kyoo Hyung Lee, M.D.

Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Correspondence to：Kyoo Hyung Lee, M.D. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea Tel: +82-2-3010-3210, Fax: +82-2-3010-6961 E-mail: khlee2@amc.seoul.kr

Received 20 March 2006 Revised 12 May 2006 Accepted 9 June 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

All-trans retinoic acid (ATRA) is the standard induction treatment for acute promyelocytic leukemia (APL). Renal involvement sometimes necessitates a dose reduction or discontinuation of induction therapy for hematological malignancies. We report here on a case of APL that achieved complete remission with low-dose ATRA treatment despite the patient's acute renal failure. A 42-year-old woman presented with a 2 month history of ecchymosis and she was subsequently diagnosed with APL. During induction treatment with ATRA and idarubicin, oliguria developed and her azotemia rapidly progressed. Because of the progressive deterioration in her general condition, the patient was transferred to the intensive care unit. We started renal replacement therapy for her acute renal failure and we discontinued ATRA treatment. Her urine output started to increase, and there was an improvement in the patient's general condition. We resumed low-dose ATRA treatment. She achieved complete remission after 52 days of treatment.

Keywords: All-trans retinoic acid, Renal insufficiency, Acute promyelocytic leukemia

REFERENCES

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Fig. 1

The time course of change of BUN and creatinine during remission induction therapy.

Fig. 2

The time course of change of amylase and lipase during remission induction therapy.

Table 1.

Laboratory datas during remission induction therapy

	D1	D17	D19	D21	D24	D27	D33	D52	D58
WBC (/μL)	13,600	5,400	2,800	2,200	900	400	2,300	8,500	7,300
BUN (mg/dL)	9	20	31	37	46	153	142	68	30
Cr (mg/dL)	0.8	1.6	2.6	4.8	2.4	7.2	9.9	7.1	3.7
Amylase (U/dL)	58			441	221		136	96
Lipase (U/dL)	3			199	99		69	50
FDP (mg/dL)	40	320			320	10
D-dimer (ug/dL)	30.40	51.60			27.20	3.50

Abbreviations: WBC, white blood cells; Cr, creatinine BUN, blood urea nitrogen; FDP, fibrin degradation product.

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