Scientific Letters
Vol. 17 No. 1 (2025): Review Articles, Original Article, Scientific Letter, Case Reports Letter to the Editor
Long-term persistence of dysplastic features in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and arsenic trioxide
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: March 3, 2025
Accepted: April 14, 2025
Accepted: April 14, 2025
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The introduction of arsenic trioxid (ATO) associated to all-trans retinoic acid (ATRA) is the therapeutic standard for standard-risk acute promyelocytic leukemia (APL). ATO has been shown to induce dysplastic changes on bone marrow progenitor cells. Despite that, observational studies evaluating bone marrow morphology during follow-up of APL patients treated with the ATRA-ATO combination are lacking. Hence, we conducted a retrospective study to evaluate morphological characteristics of bone marrow smears at different time-points during the follow up of 8 patients successfully treated with ATRA-ATO (end of consolidaton and 12 monts after end of therapy), as compared to those of 3 patients treated with the AIDA protocol. At 12 months after end of treatment, we highlighted higher grade of megakaryocytic dysplasia and increased promonocyte counts in patients treated with ATRA/ATO versus AIDA (p=0.026 and p=0.030 respectively), suggesting a long-term dysplastic effect of arsenic trioxide. Despite the morphological alterations described, none of the patients treated with ATRA-ATO developed cytopenia or a secondary myeloid neoplasm during follow-up, configuring an “idiopathic dysplasia of unknown significance” (IDUS).
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Supporting Agencies
AIRC 5_1000, MUR-PNRR M4C2I1.3 PE6 project PE00000019 Heal Italia, PRIN grant P2022W25EA, Bando Ricerca Finalizzata 2018, NET-2018-12365935How to Cite
“Long-term persistence of dysplastic features in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and arsenic trioxide” (2025) Mediterranean Journal of Hematology and Infectious Diseases, 17(1), p. e2025038. doi:10.4084/MJHID.2025.038.
Copyright (c) 2025 Enrico Santinelli, Maria Rosaria Pascale, Luca Guarnera, Arianna Savi, Flavia Mallegni, Carmelo Gurnari, Luca Maurillo, Maria Teresa Voso, Susanna Fenu
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
