Bone marrow necrosis following ALL-trans retinoic acid therapy for acute promyelocytic leukaemia.

Acute promyelocytic leukaemia (APL) (FAB-M3) is associated with fatal haemorrhagic complications in 10 to 20% of patients. Recently ALL-Trans Retinoic acid (ALL-Trans RA) therapy has been used with rapid correction of the coagulopathy. Although minimal haematologic toxicity has been reported, a number of potentially serious side-effect have been described. We report a case of bone marrow necrosis occurring in a patient with APL treated with ALL-Trans RA. The possible relationship of this complication to retinoid therapy is discussed. This patient subsequently recovered and not only achieved complete remission but tolerated two cycles of chemotherapy without problems.