Successful remission induction with reduced-dose all-trans retinoic acid for acute promyelocytic leukemia complicated by COVID-19

• Published in: Rinshō ketsueki Vol. 65; no. 6; p. 498
• Main Authors: Fujimoto, Rintaro, Kamae, Tsuyoshi, Kamijo, Kimimori, Yasumi, Masato, Karasuno, Takahiro
• Format: Journal Article
• Language: Japanese
• Published: Japan 2024
• Subjects: Adult; COVID-19 - complications; Disseminated Intravascular Coagulation - drug therapy; Disseminated Intravascular Coagulation - etiology; Humans; Leukemia, Promyelocytic, Acute - complications; Leukemia, Promyelocytic, Acute - drug therapy; Male; Remission Induction; Treatment Outcome; Tretinoin - administration & dosage; Tretinoin - therapeutic use; COVID-19; All-trans retinoic acid; Acute promyelocytic leukemia
• ISSN: 0485-1439
• DOI: 10.11406/rinketsu.65.498

A 43-year-old man with pancytopenia was diagnosed with acute promyelocytic leukemia (APL). On the first day of induction therapy with all-trans retinoic acid (ATRA) alone, he presented with high fever and was found to have coronavirus disease 2019 (COVID-19) infection by SARS-CoV2 antigen test. While it is generally recommended to delay treatment for APL patients with COVID-19 unless urgent APL treatment is required, this patient needed to continue treatment due to APL-induced disseminated intravascular coagulation (DIC). Considering the challenge of distinguishing between differentiation syndrome (DS) and COVID-19 exacerbation, the ATRA dosage was reduced to 50%. The patient was able to continue treatment without development of DS or exacerbation of DIC, leading to his recovery from COVID-19 and remission of APL.