The Management of Acute Promyelocytic Leukemia Presenting During Pregnancy

Acute promyelocytic leukemia is recognized to occur infrequently during pregnancy. The prognosis is good for acute promyelocytic leukemia with modern therapy including treatment with all-trans-retinoic acid that specifically targets the causative retinoic acid receptor (PML-RAR)α oncoprotein; however, the management of this disease in pregnancy is complex. This is because there are a number of possible treatment strategies that have varying implications for the mother and fetus. We describe a recent experience relating to 3 consecutive cases arising in the United Kingdom that demonstrates the different therapeutic decisions that can be taken and the various outcomes that can occur during pregnancy. In each case, treatment response was subject to stringent monitoring by real-time quantitative polymerase chain reaction for the PML-RARA fusion transcript. We have reviewed the available literature and, when possible, we have outlined the treatment strategies available for each stage of pregnancy.