Genital Ulcer Development in Patients with Acute Promyelocytic Leukaemia Treated with All-Trans Retinoic Acid: A Case Series

Abstract

We report here four cases of genital ulcers that developed after the administration of all-trans retinoic acid (ATRA) for the treatment of acute promyelocytic leukemia (APL). Between October 2007 and March 2010, three males and one female (age range 19-35 years) were identified to have genital ulcers after being prescribed all-trans retinoic acid (ATRA) as a part of chemotherapy for APL. This is the first series of cases describing genital ulcers, as a unique and rare complication of ATRA used for treatment of APL in these patients, with no other cause identified. Following temporary cessation of ATRA for a few days in these three cases, improvement of the ulcers was noted

Characteristics and Prognosis of Adult Acute Myeloid Leukemia with Internal Tandem Duplication in the FLT3 Gene

“…As most studies indicate FLT3/ITDs to be linked with high WBC counts, 7,16-20 one expects the incidence rates to be somewhat over estimated, as illustrated in Table 2. Incidence rates in the studies can also be influenced by source material (peripheral blood, BM or plasma DN), 21,22 or the techniques used to amplify and detect the FLT3 mutations. Most of the studies were based on PCR amplification of genomic DNA or RNA, followed by simple agarose gel electrophoresis.…”

Rare labial ulcer related to the use of all‐trans retinoic acid in a patient with acute promyelocytic leukemia

“…Divergent opinions are found in the literature . Some authors suggest that the these ulcers can managed without discontinuing ATRA provided that it is associated with a corticosteroid . In the present case, ATRA was suspended because the patient was exhibiting severe signs of the RAS (dyspnea).…”

“…This leads the medical team to introduce empirical treatment for fungal, bacterial and/or viral infections, which are usually the most common causes of lesions in these patients. However, these medications do not promote the improvement of such lesions . In the present case, given the very low platelet and leukocyte counts at the time of the onset of the oral ulcer, the medical team choose to initiate empirical treatment for fungal, viral, and bacterial infection.…”

“…Genital ulcers, especially in the scrotum, and only two cases of oral ulcerations associated with the use of ATRA have been reported in the literature . To the best of our knowledge, this paper reports the third case of oral ulceration associated with ATRA.…”

“…Painful ulcerations are associated with ATRA, manly in the genital region. Based on case reports, ulcers seem to occur more in white, middle‐aged male patients . Two cases of ulcers located in the oral region associated with the use of ATRA have previously been described .…”