scholarly journals Massive pulmonary embolism at the onset of acute promyelocytic leukemia

2016 ◽  
Vol 8 ◽  
pp. 2016027 ◽  
Author(s):  
Federica Sorà ◽  
Patrizia Chiusolo ◽  
Luca Laurenti
Keyword(s):  
Pulmonary Embolism ◽  
Retinoic Acid ◽  
Acute Promyelocytic Leukemia ◽  
Massive Pulmonary Embolism ◽  
Promyelocytic Leukemia ◽  
Early Complication ◽  
Trans Retinoic Acid ◽  
All Trans Retinoic Acid ◽  
First Case ◽  
Life Threatening

Life-threatening bleeding is a major and early complication of acute promyelocytic leukemia (APL), but in the last years there is a growing evidence of thromboses in  APL. We report the first case of a young woman with dyspnea as the first symptom of APL due to massive pulmonary embolism (PE) successfully treated with thrombolysis for PE and heparin. APL has been processed with a combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) obtaining complete remission.

scholarly journals Multiple adverse drug reactions during all-trans retinoic acid treatment for acute promyelocytic leukemia: differentiation syndrome, bradycardia, intestinal necrosis

2020 ◽  
Vol 1 (2) ◽  
pp. 109-116
Author(s):  
Valeria Ferla ◽  
Mariarita Sciumé ◽  
Umberto Gianelli ◽  
Luca Baldini ◽  
Nicola Stefano Fracchiolla
Keyword(s):  
Retinoic Acid ◽  
Acute Promyelocytic Leukemia ◽  
Adverse Drug Reactions ◽  
Leukocytoclastic Vasculitis ◽  
Promyelocytic Leukemia ◽  
Drug Reactions ◽  
Intestinal Necrosis ◽  
Trans Retinoic Acid ◽  
All Trans Retinoic Acid ◽  
Life Threatening

Abstract All-trans retinoic acid (ATRA) induces complete remission in a high proportion of acute promyelocytic leukemia (APL). Nevertheless it is be associated with adverse drug reactions that might be life-threatening including differentiation syndrome, myocarditis, myositis, Sweet’s syndrome and ulcers. We describe a case of APL who during induction therapy developed ATRA syndrome, cardiac arrhythmia and multiple episodes of intestinal necrosis that required surgery. In particular, we report here for the first intestinal necrosis attributable to ATRA treatment in the absence of histological evidence of promyelocytes infiltration or leukocytoclastic vasculitis. Keywords Acute promyelocytic leukemia, all-trans retinoic acid, adverse drug reaction

scholarly journals Acute promyelocytic leukemia, hypogranular variant: a rare presentation

2011 ◽  
Vol 1 (1) ◽  
pp. 11 ◽  
Author(s):  
Kafil Akhtar ◽  
Shamshad Ahmad ◽  
Rana K. Sherwani
Keyword(s):  
Retinoic Acid ◽  
Early Diagnosis ◽  
Acute Promyelocytic Leukemia ◽  
Rare Case ◽  
Promyelocytic Leukemia ◽  
Diagnostic Challenge ◽  
Rare Presentation ◽  
Trans Retinoic Acid ◽  
All Trans Retinoic Acid ◽  
Life Threatening

Early diagnosis of acute promyelocytic leukemia (APL) is essential because of its associated life threatening coagulopathy and unique response to all trans-retinoic acid (ATRA) therapy. The characteristic cell morphology supplemented by cytochemistry offers the most rapid means for diagnosis. Here we describe a rare case of acute promyelocytic leukemia-hypogranular variant that poses particular diagnostic challenge.

How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia

Blood ◽  
2014 ◽  
Vol 123 (18) ◽  
pp. 2777-2782 ◽  
Author(s):  
Miguel A. Sanz ◽  
Pau Montesinos
Keyword(s):  
Retinoic Acid ◽  
Arsenic Trioxide ◽  
Acute Promyelocytic Leukemia ◽  
Signs And Symptoms ◽  
Promyelocytic Leukemia ◽  
Preventive Strategy ◽  
Trans Retinoic Acid ◽  
All Trans Retinoic Acid ◽  
Unexplained Fever ◽  
Life Threatening

Abstract Differentiation syndrome (DS), formerly known as retinoic acid syndrome, is a relatively common and potentially severe complication seen in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and/or arsenic trioxide. The full-blown syndrome consists of unexplained fever, weight gain, dyspnea with pulmonary infiltrates, pleuropericardial effusion, hypotension, and renal failure. Most measures currently used for management of DS have very little evidence-based support, and therefore, many remain controversial. Despite the lack of evidence supporting DS prophylaxis, several groups have adopted a preventive strategy with corticosteroids, especially for patients with leukocyte levels higher than from 5 to 10 × 109/L. DS diagnosis should be suspected in the presence of any of the above-mentioned signs and symptoms, and preemptive treatment with dexamethasone should be started immediately. Other supportive measures can also be crucial for the correct management of DS, especially in those patients with life-threatening complications. Temporary discontinuation of all-trans retinoic acid or arsenic trioxide is indicated only for patients in very poor clinical condition or with severe renal or pulmonary dysfunction, sometimes requiring admission to the intensive care unit. Recognition of specific biomarkers and a better understanding of DS pathogenesis can be helpful for the development of specific therapies to counteract DS in a timely manner.

Hypercalcemia associated with the interaction between all trans retinoic acid and posaconazole in an acute promyelocytic leukemia case

2021 ◽  
pp. 107815522110078
Author(s):  
Hacer Berna Afacan Ozturk ◽  
Murat Albayrak ◽  
Senem Maral ◽  
Merih Reis Aras ◽  
Fatma Yilmaz ◽  
...  
Keyword(s):  
Retinoic Acid ◽  
Acute Promyelocytic Leukemia ◽  
Serum Calcium ◽  
Promyelocytic Leukemia ◽  
Cytochrome P450 Enzymes ◽  
Trans Retinoic Acid ◽  
All Trans Retinoic Acid ◽  
Normal Ranges ◽  
Rare Side Effect ◽  
High Level

Introduction All-trans retinoic acid (ATRA) is a physiological metabolite of vitamin A and it is used for the treatment of acute promyelocytic leukemia (APL). Hypercalcemia is a rare side effect of ATRA and it may be potentiated after interaction of ATRA with azole group antifungals. Herein, we have reported an APL case with hypercalcemia that is caused by the interaction of ATRA and posaconazole. Case Report A 49-year-old female patient was diagnosed as APL after the examinations performed upon the detection of pancytopenia when she had presented with the complaints of widespread bruising and fever. After the initiation of posaconazole and ATRA, her serum calcium levels begin to increase (10.3 to 11.1mg/dl). Her vitamin D level was 21.9 ng/ml and PTH 17.8 pg/ml, both were in the normal ranges. The Drug Interaction Probability Scale score of our case was calculated as 6, indicating that the probable adverse drug reaction. Therefore, the high level of serum calcium was attributed to the interaction between ATRA and posaconazole. Management & Outcome Although hypercalcemia with ATRA and other antifungal agents have been previously reported in the literature, this is the first report of hypercalcemia with the concomitant use of ATRA and posaconazole. Discussion This case highlights the importance of monitoring ATRA’s side effects when it is used in combination with drugs inhibiting the cytochrome P450 enzymes. In conclusion, the concomitant use of posaconazole and ATRA may lead to hypercalcemia and serum calcium levels return to normal ranges with the discontinuation of these drugs.

Hypercalcemia associated with all-trans-retinoic acid in the treatment of acute promyelocytic leukemia

1993 ◽  
Vol 17 (5) ◽  
pp. 441-443 ◽  
Author(s):  
Masae Sakakibara ◽  
Motoki Ichikawa ◽  
Yoshiro Amano ◽  
Shigeyuki Matsuzawa ◽  
Kazunaga Agematsu ◽  
...  
Keyword(s):  
Retinoic Acid ◽  
Acute Promyelocytic Leukemia ◽  
Promyelocytic Leukemia ◽  
Trans Retinoic Acid ◽  
All Trans Retinoic Acid
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