A 47-year-old woman comes to the physician because of easy bruising and fatigue. She appears pale. Her temperature is 38°C (100.4°F). Examination shows a palm-sized hematoma on her left leg. Abdominal examination shows an enlarged liver and spleen. Her hemoglobin concentration is 9.5 g/dL, leukocyte count is 12,300/mm3, platelet count is 55,000/mm3, and fibrinogen concentration is 120 mg/dL (N = 150-400). Cytogenetic analysis of leukocytes shows a reciprocal translocation of chromosomes 15 and 17. Which of the following is the most appropriate treatment for this patient at this time?

Question

Quizplus · Accepted Answer

Eductional Objective: Retinoic acid binds its nuclear receptors to stimulate histone acetylation, which promotes gene expression that regulates the maturation and proliferation of granulocytes. The t(15;17) translocation causes acute promyelocytic leukemia by altering the retinoic acid receptor such that physiologic levels of retinoic acid no longer activate it. High-dose all-trans retinoic acid activates the mutated receptor and thereby restores maturation of otherwise malignant granulocytes.

A 47-Year-Old Woman Comes to the Physician Because of Easy