Differentiation Syndrome; Post-ATRA/ATO Induction Therapy in Acute Promyelocytic Leukemia
Acute Promyelocytic Leukemia
DOI:
https://doi.org/10.54393/pjhs.v4i10.1070Keywords:
Acute, Promyelocytic, Leukemia, Differentiation SyndromeAbstract
Acute promyelocytic leukemia (APL) is a disease described as definite morphological and cytogenetical abnormalities and leads to coagulopathy leaving the patient in a life-threatening condition. A specific chromosomal translocation of 15 and 17 chromosomes leads to retinoic acid receptor-α (RARα) and promyelocytic leukemia (PML) genes fusion that produces an abnormal gene mutation forming an oncogenic protein which is (PML-RARα). Those APL patients, who have been treated with all-trans retinoic acid (ATRA) or arsenic trioxide (ATO) commonly lead a complicated condition called differentiation syndrome which is rarely severe. This case report explains the 37-years old male diagnosed with acute promyelocytic leukemia and later developed a differentiation syndrome after initiation of all-trans retinoic acid and arsenic trioxide induction therapy.
References
Watts JM and Tallman MS. Acute promyelocytic leukemia: what is the new standard of care? Blood Reviews. 2014 Sep; 28(5): 205-12. doi: 10.1016/j.blre.2014.07.001. DOI: https://doi.org/10.1016/j.blre.2014.07.001
Cingam SR and Koshy NV. Acute Promyelocytic Leukemia. StatPearls Publishing; 2022.
Sullivan EJ and Decker PJ. Effective leadership and management in nursing. AJN The American Journal of Nursing. 1998 Jun; 98(6): 16L. doi: 10.1097/00000446-199806000-00014. DOI: https://doi.org/10.1097/00000446-199806000-00014
Barbui T, Thiele J, Gisslinger H, Kvasnicka HM, Vannucchi AM, Guglielmelli P, et al. The 2016 WHO classification and diagnostic criteria for myeloproliferative neoplasms: document summary and in-depth discussion. Blood Cancer Journal. 2018 Feb; 8(2): 15. doi: /10.1038/s41408-018-0054-y. DOI: https://doi.org/10.1038/s41408-018-0054-y
Stahl M and Tallman MS. Differentiation syndrome in acute promyelocytic leukaemia. British Journal of Haematology. 2019 Oct; 187(2): 157-62. doi: 10.1111/bjh.16151. DOI: https://doi.org/10.1111/bjh.16151
Sarkar S, Ghosh P, Gehani A, Ghara N, Bhattacharyya P. Multidisciplinary corroboration in differentiation syndrome: a case report. Journal of Medical Case Reports. 2021 Dec; 15(1): 1-5. doi: 10.1186/s13256-021-02790-w. DOI: https://doi.org/10.1186/s13256-021-02790-w
Montesinos P and Sanz MA. The differentiation syndrome in patients with acute promyelocytic leukemia: experience of the pethema group and review of the literature. Mediterranean Journal of Hematology and Infectious Diseases. 2011 Dec; 3(1): e2011059. doi: 10.4084/MJHID.2011.059. DOI: https://doi.org/10.4084/mjhid.2011.059
Gasparovic L, Weiler S, Higi L, Burden AM. Incidence of differentiation syndrome associated with treatment regimens in acute myeloid leukemia: a systematic review of the literature. Journal of Clinical Medicine. 2020 Oct; 9(10): 3342. doi: 10.3390/jcm9103342 DOI: https://doi.org/10.3390/jcm9103342
Sanz MA and Montesinos P. How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia. Blood, The Journal of the American Society of Hematology. 2014 May; 123(18): 2777-82. doi: 10.1182/blood-2013-10-512640. DOI: https://doi.org/10.1182/blood-2013-10-512640
Norsworthy KJ, Mulkey F, Scott EC, Ward AF, Przepiorka D, Charlab R, et al. Differentiation syndrome with ivosidenib and enasidenib treatment in patients .with relapsed or refractory IDH-mutated AML: a US Food and Drug Administration systematic analysis. Clinical Cancer Research. 2020 Aug; 26(16): 4280-8. doi: 10.1158/1078-0432.CCR-20-0834. DOI: https://doi.org/10.1158/1078-0432.CCR-20-0834
Rego EM and De Santis GC. Differentiation syndrome in promyelocytic leukemia: clinical presentation, pathogenesis and treatment. Mediterranean Journal of Hematology and Infectious Diseases. 2011 Oct; 3(1): e2011048. doi: 10.4084/MJHID.2011.048. DOI: https://doi.org/10.4084/mjhid.2011.048
Larson RA, Bag R, Lowenberg B, Rosmarin AG. Differentiation syndrome associated with treatment of acute leukemia. UpToDate. 2023 Jul.
Frankel SR, Eardley A, Lauwers G, Weiss M, Warrell Jr RP. The" retinoic acid syndrome" in acute promyelocytic leukemia. Annals of Internal Medicine. 1992 Aug; 117(4): 292-6. doi: 10.7326/0003-4819-117-4-292. DOI: https://doi.org/10.7326/0003-4819-117-4-292
Burnett AK, Russell NH, Hills RK, Bowen D, Kell J, Knapper S, et al. Arsenic trioxide and all-trans retinoic acid treatment for acute promyelocytic leukaemia in all risk groups (AML17): results of a randomised, controlled, phase 3 trial. The Lancet Oncology. 2015 Oct; 16(13): 1295-305. doi: 10.1016/S1470-2045(15)00193-X. DOI: https://doi.org/10.1016/S1470-2045(15)00193-X
Reyhanoglu G, Hughes B, King KE, Cambridge R. Differentiation syndrome, a side effect from the therapy of acute promyelocytic leukemia. Cureus. 2020 Dec; 12(12): e12042. doi: 10.7759/cureus.12042. DOI: https://doi.org/10.7759/cureus.12042
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments
