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Abstract
Bleeding complications are often associated with acute promyelocytic leukemia (APL) they occur frequently at the onset of APL and become more serious during chemotherapy. The increased bleeding tendency of APL is caused by a massive proteolytic state, triggered by procoagulant substances, plasminogen activators and proteinases released into the circulation from leukemic cells. The introduction of all-trans-retinoic acid (ATRA) into the treatment of APL has reduced bleeding complications. However the mechanisms of the hemostatic defects in patients with APL and their modifications during ATRA with or without chemotherapy are still incompletely understood. Attempts at characterizing and monitoring these hemostatic abnormalities have been made by using several laboratory parameters. Among them we have studied the structural modifications of von Willebrand Factor (vWF). In APL, plasma vWF is massively degraded, with specific fragments produced by the action of plasmin and elastase. After ATRA therapy, proteolysis diminishes progressively in parallel with the improvement of other hemostatic measurements. We conclude that abnormalities of vWF structure and function might adversely affect hemostasis in APL and that their improvement after ATRA administration might explain in part the effectiveness of this drug in reducing hemorrhagic complications.