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Extramedullary Relapse of Acute Promyelocytic Leukemia in the Middle Ear after All-Trans Retinoic Acid Combined with Chemotherapy

Year: 2026

Type: article

Abstract: A 69-year-old man with acute promyelocytic leukemia in molecular remission and no detectable PML::RARA transcripts in his peripheral blood cells developed acute otitis media. After 10 months, tympanomastoidectomy was performed for suspected secondary cholesteatoma. A histological examination confirmed extramedullary relapse with PML::RARA-positive cell infiltration. The patient achieved a second molecular remission after treatment with arsenic trioxide. Our findings suggest that (1) a diagnostic sample may be obtained from mastoid air cells rather than from the middle ear cavity, (2) molecular remission does not preclude extramedullary relapse, and (3) all-trans retinoic acid and arsenic trioxide combination therapy may reduce the risk of extramedullary relapse.

Source: Internal Medicine

DOI: 10.2169/internalmedicine.8006-26

Authors: Noriko Tsuge, Taisuke Kobayashi, Masahiro Komori, Ichiro Murakami, Tatsuya Negishi, Shohei Shigeto, Yuta Tsunaga, Keito Ohara, Shinichiro Watanabe, Shohei Yoshida, Kensuke Kojima

Institutions: University of Kochi, Kōchi University, Shinshu University Hospital

Language: English

Topic: Retinoids in leukemia and cellular processes

Subfield: Molecular Biology

Field: Biochemistry, Genetics and Molecular Biology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7214607331

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