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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Keywords
dysplasia, acute promyelocytic leukemia, arsenic trioxide
Abstract
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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