Abstract
<title>Abstract</title> <p>Acute promyelocytic leukemia (APL) accounts for 10–15% of cases of acute myeloid leukemia. APL during pregnancy poses a clinical challenge due to a lack of guidelines on its management in this context. We present a unique case of a patient with high risk APL who was pregnant twice during the course of their disease, at diagnosis and during maintenance treatment. The first pregnancy was terminated, and treatment was rapidly initiated. For the second pregnancy, maintenance therapy was held while the patient was in a complete molecular remission, resulting in an uncomplicated pregnancy with birth of a healthy child at term despite brief exposure to ATRA and 6-Mercaptopurine in the first trimester. We conducted a comprehensive literature review, which found favourable CR rates, maternal outcomes, and live birth rates with ATRA containing regimens, particularly when APL was diagnosed in later trimesters, however prematurity rates were high and fetal structural anomalies were observed.</p>