Bone Marrow Findings in Patients With Acute Promyelocytic Leukemia Treated With Arsenic Trioxide

Karin P. Miller, Girish Venkataraman, Christopher D. Gocke, Denise A. Batista, Michael J. Borowitz, Kathleen H. Burns, Keith Pratz, Amy S. Duffield

Research output: Contribution to journalArticlepeer-review


Objectives: Increasingly, acute promyelocytic leukemia (APL) is treated with a combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). This study characterizes bone marrow findings after ATRA/ATO therapy. Methods: Bone marrow biopsies from 16 patients treated with ATRA/ATO and seven patients treated with ATRA/chemotherapy (CTX) for APL were evaluated. Results: In ATRA/ATO cases, the marrow was likely to be hypercellular (79%) with a decreased myeloid:erythroid (M:E) ratio (88%), megaloblastoid maturation of erythroid precursors (100%), erythroid atypia (75%), and increased (88%) and atypical (75%) megakaryocytes. Significant myeloid atypia was only seen in extensive residual disease. The ATRA/CTX cases were less likely to be hypercellular (38%), have a M:E ratio of 1:1 or less (0%), exhibit significant erythroid atypia (0%), or have increased (0%) or atypical (38%) megakaryocytes. Conclusions: Bone marrow biopsies from patients treated with ATO have unusual but characteristic features. Despite variability in marrow findings, clinical outcomes were uniformly favorable.

Original languageEnglish (US)
Pages (from-to)675-685
Number of pages11
JournalAmerican journal of clinical pathology
Issue number5
StatePublished - Oct 7 2019


  • Acute promyelocytic leukemia
  • All-trans retinoic acid
  • Arsenic trioxide

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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