Bradycardia following retinoic acid differentiation syndrome in a patient with acute promyelocytic leukaemia

McGregor, Andrew; Hurst, Erin; Lord, Stephen R.; Jones, Gail

doi:10.1136/bcr.02.2012.5848

Cited by 4 publications

(6 citation statements)

References 15 publications

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“…6 Sinus node dysfunction with asymptomatic junctional bradycardia was also reported in a 28-year-old woman after sepsis and RAS related to ATRA and anthracycline-based chemotherapy. 7 There was only one previous case report of suspected ATRA-related CAVB, which was reported in the Japanese literature. 8 The CAVB presented as an unexplained sudden AdamseStokes syncope on the 25 th day of induction therapy after enocitabine, mitoxantrone, and ATRA therapy.…”

Section: Discussionmentioning

confidence: 97%

All- trans retinoic acid-induced, life-threatening complete atrioventricular block

Shih¹,

2015

Journal of the Chinese Medical Association

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We report a case of complete atrioventricular block (CAVB) with ventricular asystole and recurrent AVBs due to all-trans retinoic acid (ATRA). A 57-year-old man with acute promyelocytic leukemia was undergoing induction therapy with ATRA and developed episodic seizures with altered consciousness on the 14(th) day and then CAVB followed by cardiac arrest on the 15(th) day. Although he initially recovered after resuscitation, he suffered from recurrent CAVB, which persisted for 3 days despite immediate ATRA discontinuation. He then received ATRA retreatment with reduction of dosage, but a high-degree AVB recurred on the 5(th) day. After discontinuation of ATRA therapy, the patient recovered 3 days later without any cardiovascular event during follow-up. The serial electrocardiogram changes suggested an infra-Hisian block with possible ATRA dose-response relationship. To our knowledge, this is the first established case of ATRA-induced CAVB in the literature. We suggest clinical alertness for this life-threatening complication.

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Section: Discussionmentioning

confidence: 97%

All- trans retinoic acid-induced, life-threatening complete atrioventricular block

Shih¹,

2015

Journal of the Chinese Medical Association

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“…Bradyarrhythmia is a rare adverse event during ATRA treatment, previously described only in two cases. McGregor et al [ 14 ], described bradycardia in a patient receiving ATRA and idarubicin, following ATRA syndrome occurrence. Maruhash et al [ 15 ], described a patient who developed bradycardia after three days of ATRA therapy, which did not improve with medical therapy and worsened following ATRA re-challenge.…”

Section: Discussionmentioning

confidence: 99%

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

Ferla

Sciumè

Gianelli

et al. 2020

Exploration of Targeted Anti-Tumor Therapy

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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

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“…Arrhythmia resolved in two patients without interruption of ATRA [ 12 , 14 ]. Sinus rhythm was restored in another four cases within 3–15 days after discontinuing ATRA [ 11 , 13 , 15 ]. Three of them required temporary pacemaker support [ 11 , 15 ], and ATRA was rechallenged in two of them [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, all of the incidents reported in the seven cases occurred during the induction therapy. Among the four cases with available information, three of them also experienced DS [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to these mechanisms, DS may also interfere with AV node conduction and result in bradyarrhythmia. In reviewing the incidents of ATRA-related bradycardia, three of four cases with available information also experienced DS [ 12 , 13 ]. In Dhar's report, second-degree AV block simultaneously occurred with DS, and after steroid use, these manifestations resolved at the same time [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Bradycardia during Induction Therapy with All-trans Retinoic Acid in Patients with Acute Promyelocytic Leukemia: Case Report and Literature Review

Chen

et al. 2018

Case Reports in Hematology

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A 41-year-old man with newly diagnosed acute promyelocytic leukemia (APL) received induction chemotherapy, containing all-trans retinoic acid (ATRA), idarubicin, and arsenic trioxide. On the 11th day of therapy, he experienced complete atrioventricular (AV) block; therefore, ATRA and arsenic trioxide were immediately postponed. His heart rate partially recovered, and ATRA was rechallenged with a half dose. However, complete AV block as well as differentiation syndrome recurred on the next day. ATRA was immediately discontinued, and a temporary pacemaker was inserted. Two days after discontinuing ATRA, AV block gradually improved, and ATRA was uneventfully rechallenged again. The Naranjo adverse drug reaction probability scale was 7 for ATRA, suggesting it was the probable cause of arrhythmia. A literature search identified 6 other cases of bradycardia during ATRA therapy, and all of them occurred during APL induction therapy, with onset ranging from 4 days to 25 days. Therefore, monitoring vital signs and performing electrocardiogram are highly recommended during the first month of induction therapy with ATRA. ATRA should be discontinued if complete AV block occurs. Rechallenging with ATRA can be considered in fully recovered and clinically stable patients.

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Bradycardia following retinoic acid differentiation syndrome in a patient with acute promyelocytic leukaemia

Cited by 4 publications

References 15 publications

All- trans retinoic acid-induced, life-threatening complete atrioventricular block

All- trans retinoic acid-induced, life-threatening complete atrioventricular block

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

Bradycardia during Induction Therapy with All-trans Retinoic Acid in Patients with Acute Promyelocytic Leukemia: Case Report and Literature Review

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