A Case of Life-Threatening Retinoic Acid Syndrome and Review of Literature

Abstract

All-trans-retinoic acid represents a major progress that has made acute promyelocytic leukemia the most curable subtype of acute myeloid leukemia in adults. Although all-trans-retinoic acid is usually well tolerated, some patients develop the retinoic acid syndrome, characterized by unexplained fever, weight gain, respiratory distress, interstitial pulmonary infiltrates, pleural and pericardial effusions, episodic hypotension, and acute renal failure. Further studies of growth factor expression and modulation of adhesion molecules are warranted to provide further insights into the pathogenesis of the syndrome and may lead to its prevention.

Retinoid Chemoprevention: Who Can Benefit?

“…Adults are also susceptible to side effects of excessive amounts of retinoic acid. For example, the adult hippocampus is very sensitive to extreme amounts of retinoic acid, as reviewed in [14]; and differentiation syndrome (retinoic acid syndrome) is a life threatening pathological sequela of high doses of therapeutic retinoic acid, as reviewed in [15]. Many of the effects of extreme doses of retinoic acid are systemic, affecting many cell types and their interactions.…”

All trans retinoic acid induced hypercalcemia and diffuse alveolar hemorrhage in acute promyelocytic leukemia: Practical guidelines for diagnosis and treatment based on a case report and literature review

“…Although all trans-retinoic acid (ATRA) has been a breakthrough in the treatment of acute promyelocytic leukemia (APL) since 1988, number of complications appeared and were considered to be related to the treatment itself [1][2][3][4][5][6][7][8] . The most dreadful was called retinoic acid syndrome (RAS), also known as differentiation syndrome, which was believed to be due to maturation of blast cells.…”