Differentiation Therapy of Acute Promyelocytic Leukemia with Tretinoin (All-trans-Retinoic Acid)

作者：Raymond P. Warrell, Stanley R. Frankel, Wilson H. Miller, David A. Scheinberg, Loretta Marie Itri, Walter N. Hittelman, Rohini C. Vyas, Michael Andreeff, Agostino Tafuri, Ann Alice Jakubowski, Janice Lynn Gabrilove, Michael S. Gordon, Ethan Dmitrovsky · 发表于：New England Journal of Medicine · 年份：1991 · DOI：10.1056/nejm199105163242002 · 被引用次数：1287 · 研究领域：Retinoids in leukemia and cellular processes、Acute Myeloid Leukemia Research、Drug-Induced Ocular Toxicity

BACKGROUND AND METHODS: Patients with acute promyelocytic leukemia have a characteristic (15;17) translocation, with a breakpoint on chromosome 17 in the region of the retinoic acid receptor-alpha (RAR-alpha). Since this receptor has been shown to be involved with growth and differentiation of myeloid cells in vitro, and since recent clinical studies have reported that tretinoin (all-trans-retinoic acid) induces complete remission in patients with acute promyelocytic leukemia we studied the effects of tretinoin on cellular maturation and molecular abnormalities in patients undergoing the induction of remission with this agent. RESULTS: Eleven patients with acute promyelocytic leukemia were treated with tretinoin administered orally at a dose of 45 mg per square meter of body-surface area per day. Nine of the 11 patients entered complete remission. In two patients, complete remission was preceded by striking leukocytosis that then resolved despite continued drug treatment. Serial studies of cellular morphologic features, cell-surface immunophenotypic analysis, and fluorescence in situ hybridization with a chromosome 17 probe revealed that clinical response was associated with maturation of the leukemic clone. All patients who responded to treatment who were tested by Northern blot analysis had expression of aberrant RAR-alpha. As patients entered complete remission, the expression of the abnormal RAR-alpha message decreased markedly; however, it was still detectable in several...