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all-trans-retinoic acid (ATRA)-induced differentiation syndrome
Etiology:
- occurs in 25% of patients with acute promyelocytic leukemia who receive all-trans=retinoic acid (ATRA) or arsenic trioxide
Pathology:
- release of cytokines from differenting promyelocytes leading to capillary leak syndrome
Clinical manifestations:
- symptom onset occures within the 1st week of therapy (47%) or within the 3rd week of therapy (25%)
- dyspnea
- peripheral edema
- weight gain
- fever
- hypotension
- acute kidney injury
- variable occurence of
- pericardial effusion
- pleural effusion
- pulmonary infiltrates
Radiology:
- chest X-ray
Differential diagnosis:
- pneumonia
Management:
- dexamethasone
- treatment for pneumonia may be prudent
General
syndrome
References
- Medical Knowledge Self Assessment Program (MKSAP) 16,
American College of Physicians, Philadelphia 2012
- Montesinos P
Differentiation syndrome in patients with acute promyelocytic
leukemia treated with all-trans retinoic acid and anthracycline
chemotherapy: characteristics, outcome, and prognostic factors.
Blood. 2009 Jan 22;113(4):775-83
PMID: 18945964