Intracardiac Thrombus Associated with All-Trans-Retinoic Acid Treatment in a Child with Acute Promyelocytic Leukemia

Abstract

In acute promyelocytic leukemia (APL) potentially fatal coagulopathy and hemorrhages remain major causes of induction failure. Serious thrombotic events are frequently reported at the diagnosis or following remission induction therapy with all-trans-retinoic acid (ATRA), which is a key point in treatment of APL. On the other hand, isolated right ventricular (RV) thrombus is a life-threatening condition and in cancer patients it has been rarely reported. In this report, we have described a very rare a case of ATRA-related isolated right-sided intracardiac thrombus in a nine-year-old child with APL that developed after achievement of complete remission, during the 4th course of ATRA, which is an unexpected period for ATRArelated thrombotic events. We aimed to emphasize the importance of side effects of ATRA and increase awareness against such life-threatening complications. Thrombosis mustn’t be expected only during differentiation syndrome; it should be kept in mind in every phase of treatment with ATRA.