Retinoic Acid Syndrome Common but Treatable
Retinoic Acid Syndrome Common but Treatable
Retinoic acid syndrome is a serious, and at times fatal, complication that occurs in acute promyelocytic leukemia (APL) mostly, but not invariably, during remission induction using all-trans-retinoic acid. This syndrome is well characterized on the basis of clinical features such as fever, weight gain, edema, hypotension, dyspnea, pulmonary infiltrate, pleural effusion, pericardial effusion, renal failure, and others. Early treatment with dexamethasone for retinoic acid syndrome, however, has been associated with remarkable results.
The authors of this study found many similarities between treatment with arsenic trioxide and all-trans-retinoic acid with regard to mechanism of remission induction (ie, leukemic cell differentiation, the development of leukocytosis, and retinoic acid syndrome) in this group of patients. The statistical analyses established that patients with a higher baseline white blood cell count, and particularly those with higher peak values during remission induction, had a greater chance of developing retinoic acid syndrome. Unfortunately, the overlapping values for white blood cell count in the 2 groups of patients (with or without retinoic acid syndrome) was such that a reliable prediction would not be possible for any given patient. Thus, physicians must closely monitor the aforementioned clinical parameters for retinoic acid syndrome and begin dexamethasone therapy as soon as possible.
Retinoic acid syndrome is a serious, and at times fatal, complication that occurs in acute promyelocytic leukemia (APL) mostly, but not invariably, during remission induction using all-trans-retinoic acid. This syndrome is well characterized on the basis of clinical features such as fever, weight gain, edema, hypotension, dyspnea, pulmonary infiltrate, pleural effusion, pericardial effusion, renal failure, and others. Early treatment with dexamethasone for retinoic acid syndrome, however, has been associated with remarkable results.
The authors of this study found many similarities between treatment with arsenic trioxide and all-trans-retinoic acid with regard to mechanism of remission induction (ie, leukemic cell differentiation, the development of leukocytosis, and retinoic acid syndrome) in this group of patients. The statistical analyses established that patients with a higher baseline white blood cell count, and particularly those with higher peak values during remission induction, had a greater chance of developing retinoic acid syndrome. Unfortunately, the overlapping values for white blood cell count in the 2 groups of patients (with or without retinoic acid syndrome) was such that a reliable prediction would not be possible for any given patient. Thus, physicians must closely monitor the aforementioned clinical parameters for retinoic acid syndrome and begin dexamethasone therapy as soon as possible.
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