Differentiation syndrome in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline chemotherapy: characteristics, outcome, and prognostic factors

High dose ara-C in the treatment of newly diagnosed acute promyelocytic leukemia: long-term results of the German AMLCG

“…5,[30][31][32] The APL differentiation syndrome was diagnosed in 21.1% of our patients, which is in the range of other reports. [33][34][35][36] Possibly, the timing of ATRA and chemotherapy has contributed to the relatively high rate, as 60% of our patients received pretreatment with ATRA over a period of 7 days on average before the chemotherapy was started, as similarly observed by others. 34,35 The high rate of severe infections leading to death in CR after induction in four patients is a disadvantage of our protocol.…”

How to manage acute promyelocytic leukemia

“…53,78 The common clinical symptoms were dyspnea with interstitial pulmonary infiltrates, peripheral edema, unexplained fever, weight gain, hypotension and acute renal failure. 79 When these happen, early use of chemotherapy and high dose of dexamethasone can decrease the mortality down to 1% or lower.…”

Bone morphogenetic proteins regulate differentiation of human promyelocytic leukemia cells

“…In NB4 cells ATRA enhanced the expression of oncogene PML/RARα and total RARα, restoring RA-modulated myeloid differentiation [2,37]. In parallel, ATRA reduced apoptotic/dead population of NB4 cells, which may be related to APL-differentiation syndrome seen upon ATRA treatment [38]. Syndrome is caused by the accumulation of mature granulocytes and can lead to a fatal outcome in APL patients.…”