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Successful Control of Disseminated Intravascular Coagulation by Recombinant Thrombomodulin during Arsenic Trioxide Treatment in Relapsed Patient with Acute Promyelocytic Leukemia

DOI: 10.1155/2012/908196

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Abstract:

Disseminated intravascular coagulation (DIC) frequently occurs in patients with acute promyelocytic leukemia (APL). With the induction of therapy in APL using all-trans retinoic acid (ATRA), DIC can be controlled in most cases as ATRA usually shows immediate improvement of the APL. However, arsenic trioxide (ATO) which has been used for the treatment of relapse in APL patients has shown to take time to suppress APL cells, therefore the control of DIC in APL with ATO treatment is a major problem. Recently, the recombinant soluble thrombomodulin fragment has received a lot of attention as the novel drug for the treatment of DIC with high efficacy. Here, we present a relapsed patient with APL in whom DIC was successfully and safely controlled by rTM during treatment with ATO. 1. Brief Communication Disseminated intravascular coagulation (DIC) frequently occurs in patients with acute promyelocytic leukemia (APL), contributing to bleeding complications, especially during treatment. With the induction of therapy in APL using all-trans retinoic acid (ATRA), DIC can be controlled in most cases as ATRA usually shows immediate improvement of the APL. However, arsenic trioxide (ATO) which has recently been used for the treatment of relapse in APL patients has shown to take time to suppress APL cells, therefore the control of DIC in APL with ATO treatment is a major problem. Recently, the recombinant soluble thrombomodulin fragment (rTM, Recomodulin; Asahi Kasei Pharm, Tokyo, Japan) has received a lot of attention as the novel drug for the treatment of DIC with high efficacy [1]. DIC may however occur as a result of various diseases, such as severe infection and malignant tumors, therefore more clinical experiences using rTM for various situations are needed to know the precise indications of rTM. Here, we present a relapsed patient with APL in whom DIC was successfully and safely controlled by rTM during treatment with ATO. A 38-year-old Japanese man was diagnosed with APL in 2007. At the time of first onset of the disease, no finding indicating DIC was observed. Chemotherapy combined with ATRA was performed as induction therapy. ATRA syndrome occurred, but that was successfully improved with the administration of steroid. After consolidation therapy, molecular CR was achieved. ATRA administration was continued intermittently for 2 years as maintenance therapy; this involved eight sequential courses of the daily administration of ATRA for 2 weeks followed by a 10-week follow-up period without the use of ATRA. In 2011, however, PML-RARα fusion transcript was

References

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