Isolated gingival relapse during complete hematological remission in acute promyelocytic leukemia.

Mustafa Benekli, MD, 14. Sokak. 43/3, Bahçelievler, TR-06490 Ankara (Turkey) Many cases of acute leukemia with extramedullary involvement have been reported, and most of them are concomitant with bone marrow relapse. In the oral cavity, leukemic infiltrations of the dental pulp, mandible and tonsils were reported as isolated extramedullary relapses [1,2]. Extramedullary recurrence in acute promyelocytic leukemia (APL) is very unusual in adults. To our knowledge, isolated gingival relapse during hematological remission in APL was reported in a previous case only by Sawatari et al. [3]. We report an additional case of APL associated with isolated gingival relapse during complete hematological remission. A 19-year-old male patient was admitted to our hospital in January 1991 with fever, malaise, epistaxis and bloody otorrhea lasting for 1 month. Physical examination was normal except for petechial lesions on the lower extremities. No gingival swelling was found at that time. Anemia (Hb: 7.7 g/dl), thrombocytopenia (platelets: 24.0 × 109/l)andleukopenia(WBC:1.9 × 109/1) were detected. Peripheral blood smear showed 55% blasts. Bone marrow aspiration was hypercellular with 68% atypical, hypergranular Auer rod positive promyelocytes. The tests for disseminated intravascular coagulation (DIC) were negative. Immunophenotypic studies showed CD 13, CD33, and CD 15 positivity together with negative HLA-DR antigen. A diagnosis of acute promyelocytic leukemia was established and therapy with aclarubicin 20mg/m2 and cytarabine 100mg/m2 was given. One month later, bone marrow examination with aspiration and biopsy was repeated and found to be in remission. Cytarabine 100 mg/m2 for seven days was administered as consolidation therapy. Later, the patient was put on a maintenance therapy consisting of cytarabine 100 mg/m2 intramuscularly and 6-thioguanine 100 mg/ m2 orally 5 days in a month for 3 months and then he was called for periodic controls without any treatment. In April 1992, he was readmitted because of gingival swelling. Physical examination revealed no change except for left upper gingival swelling. Cultures of the gin-giva were obtained and revealed normal resident oral flora. Complete ■■1⁄8:. > V.3⁄81⁄8: