Retinoic acid syndrome: a review

Abstract

Summary The retinoic acid syndrome (RAS) is an unpredictable but frequent complication which may develop after administration of all‐trans retinoic acid (ATRA) most commonly in patients with acute promyelocytic leukaemia (APL). In this review, we describe the incidence, predictive factors, clinical course, outcome and treatment of RAS in patients with APL treated with ATRA. The incidence of RAS in patients receiving ATRA is about 14–16%, with an associated mortality of about 2%. Initial high white blood cell (WBC) count, rapidly increasing WBC count and/or the presence of the CD 13 expression on leukaemic cells may help in identifying patients likely to develop RAS. Concurrent chemotherapy will probably decrease the risk of developing RAS but often exacerbates bleeding, leading to leucocytosis, thrombocytopenia, disseminated intravascular coagulation and fibrinolysis. Prophylactic steroids are not recommended but prompt administration of steroids at the first sign of unexplained dyspnea, fever, weight gain or pulmonary infiltrate, is critical. Liposomal ATRA is being investigated to induce haematological cure in APL without chemotherapy and to reduce the incidence of RAS but further validation of its usefulness is necessary.

Synthetic Retinoid AM80 Inhibits Th17 Cells and Ameliorates Experimental Autoimmune Encephalomyelitis

“…In addition, the therapeutic application of RA to date has been limited by instability and poor bioavailability of this compound as well as by its nonselective binding to a broad range of retinoid receptors, which conceivably leads to unexpected side effects. 26,33,34 To circumvent these potential problems in the clinical use of RAR agonists, a variety of synthetic RAR agonists with improved biological properties in vivo have been developed. One of these synthetic retinoids, AM80, is already available as medication under the trade name Tamibarotene for human diseases such as acute promyelocytic leukemia (APL) and psoriasis.…”

Concentração de cálcio no dialisato e hipercalcemia na DRC

“…21 The ATRA dose prescribed for the patient is unusually indicated for those with APL. [9][10][11]13 However, the patient's symptoms together with the negative culture tests in the urine and the hemoglobinuria caused the suspicion of ATRA syndrome.…”

Insuficiência renal aguda em paciente tratada com ATRA e anfotericina B: relato de caso

“…21 A dose de ATRA prescrita para a paciente foi anormalmente recomendada para portadores de LPA. [9][10][11]13 Contudo, os sintomas apresentados pela paciente, juntamente dos exames de cultura negativos e hemoglobinúria no exame de urina, levantaram a suspeita de síndrome de ATRA.…”