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[Acute promyelocytic leukemia with stat5b- RARα fusiongene: a case report and literatures review].
Liu, L, Chen, S, Tan, J, Shi, P, Chen, K, Gao, D, Huang, X, Xie, Y, Xu, Y, Yang, F, et al
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi. 2016;(1):68-9
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A case of life-threatening retinoic acid syndrome and review of literature.
Tariq, Z, Phinney, RC, Mohamed, I
American journal of therapeutics. 2014;(2):e28-30
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.
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How I treat children and adolescents with acute promyelocytic leukaemia.
Abla, O, Ribeiro, RC
British journal of haematology. 2014;(1):24-38
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Abstract
Acute promyelocytic leukaemia (APL) is a rare subtype of acute myeloid leukaemia. The outcome of paediatric APL has improved substantially over the past 20 years; cure rates above 80% are expected when all-trans retinoic acid (ATRA) is given with anthracycline-based regimens. The presenting features of paediatric APL may include severe bleeding and thrombotic complications, which contribute to the high early death rate. The incidence of leucocytosis and the microgranular subtype is greater in paediatric than adult APL, and children experience greater ATRA-related toxicity. It is crucial to begin ATRA therapy and intensive platelet and fibrinogen replacement on first suspicion of APL. Recent risk-adapted therapeutic trials have shown that patients at greater risk of relapse benefit from the introduction of high-dose cytarabine during consolidation. Combination therapy with ATRA and arsenic trioxide provides very effective frontline treatment and may reduce the need for subsequent anthracycline therapy.
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Genomic analysis of the clonal origin and evolution of acute promyelocytic leukemia in a unique patient with a very late (17 years) relapse.
Zhang, X, Zhang, Q, Dahlström, J, Tran, AN, Yang, B, Gu, Z, Ghaderi, M, Porwit, A, Jia, J, Derolf, A, et al
Leukemia. 2014;(8):1751-4
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[Development of Sweet syndrome in an acute promyelocyte leukemia patient during treatment with all-trans retinoic acid--case report and literature review].
Yan, ZS, Li, DP, Jiang, EL, Zhou, CL, Liu, EB, Chen, HS, Feng, SZ, Han, MZ
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi. 2007;(7):462-5
Abstract
OBJECTIVE To identify the side effect of all-trans retinoic acid (ATRA), and improve early therapeutic response in patients with acute promyelocytic leukemia (APL). METHOD The first case of Sweet's syndrome (SS) developed in a APL patient treated with ATRA was reported in mainland of China, and reviewed correlative literature. RESULTS Only 14 cases of SS associated with ATRA therapy in APL have been reported in the literature, including the present case. The median age was 49.5 years (9 -84) and 10 were women and 4 men. Of them, SS was restricted to the skin in 10 case, the other 4 muscle, fascia, kidney, and lung were involved. SS appeared after a median of 18 days of ATRA therapy (6 - 34 days). The median WBC count was 7.05 (0.80 - 23.00) x 10(9)/L. Four patients continued with the ATRA therapy without interruption, 13 patients treated with steroids and 12 responded. One patient improved without any treatment. Two cases of SS developed retinoic acid syndromes after ATRA therapy. CONCLUSION Sweet's syndrome is a rare adverse effect of ATRA, and has similar features with inflammatory or infective dermatosis. The corticosteroids treatment could improve the systemic and cutaneous symptoms. When ATRA therapy was restarted after SS subsided, no recurrence of rashes was observed.
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[All-trans retinoic acid syndrome. Case report and a review of the literature].
Carrillo-Esper, R, Carvajal-Ramos, R, Contreras-Domínguez, V, Hernández-Aguilar, C, Romano-Estrada, L, Melo-Martínez, C
Gaceta medica de Mexico. 2004;(5):547-52
Abstract
We described a patient with acute promyelocytic leukemia (APL) who developed all-trans retinoic acid syndrome (ATRAS) and reviewed the literature. ATRAS presents in patients with APL treated with all-trans retinoic acid (ATRA). It has an incidence from 5%-27% with mortality of 29%. It is secondary to ATRA effect on promyelocyte differentiation, which causes systemic inflammatory response syndrome, endothelium damage with increase in capillary permeability, microcirculation obstruction, and tissue infiltration. ATRAS clinical manifestations are fever, hypotension, respiratory, renal and hepatic insufficiency, lung infiltrates, pleural and pericardic effusion, and generalized edema. Treatment is based on ATRA suspension, support measures, and steroids.
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Acute promyelocytic leukemia: a case-based review.
Gupta, V, Tabak, D, Keating, A
Hematology (Amsterdam, Netherlands). 2003;(2):105-13
Abstract
Retinoid therapy for acute promyelocytic leukemia (APL) is one of the major achievements of leukemia research in the last 15 years. Use of all trans retinoic acid (ATRA) has changed the prognosis of APL from a fatal leukemia to a highly curable disease. This case-based review examines the available clinical and scientific data to form evidence-based decisions in the management of APL. The main aim of this review is to highlight recent progress made in the management of APL and address the role of maintenance therapy, prognostic factors for relapse and treatment of relapsed disease.
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CNS relapses of acute promyelocytic leukemia after all-trans retinoic acid.
Burry, LD, Seki, JT
The Annals of pharmacotherapy. 2002;(12):1900-6
Abstract
OBJECTIVE To review the role of all-trans retinoic acid (ATRA) and arsenic trioxide in central nervous system (CNS) relapses of acute promyelocytic leukemia (APL). CASE SUMMARY A 69-year-old white man diagnosed with APL presented with bleeding diathesis. His molecular and cytogenetic studies were positive for promyelocytic leukemia-retinoic acid receptoralpha (PML-RARalpha) and t(15;17) transformation. Complete molecular and cytogenetic remission was achieved with ATRA, daunorubicin, and cytarabine. Within 6 months, the patient was readmitted for investigation of severe global headaches and an ataxic gait. His peripheral blood and cerebral spinal fluid were positive for PML-RARalpha fusion protein. Intrathecal chemotherapy and radiation, as well as ATRA, were the main treatment modalities provided. Molecular and cytogenetic remission was again obtained. Three months later, a second relapse occurred in the CNS and the peripheral blood. DISCUSSION APL is typically treated with anthacycline-based chemotherapy and ATRA. Approximately 85-95% of patients achieve complete remission (CR); however, the relapse rate has been reported to be about 30-40%. A thorough literature search (MEDLINE, EMBASE, CANCERLIT, 1966-January 2002) revealed only 54 cases of extramedullary disease, of which 35 involved the CNS. CONCLUSIONS The introduction of ATRA has improved patient survival dramatically. APL relapse, in general, has been in part attributable to repetitive or prolonged exposure to ATRA and the possibility of additional chromosomal changes, making the disease more refractory to treat. Given the evidence, one could argue that, with repeated ATRA treatment, CR duration may be shortened. However, limited data are available to guide the appropriate management of APL relapsed to the CNS with either ATRA, chemotherapy, or arsenic trioxide. In our opinion, treatment using arsenic trioxide is an unconventional option worthy of exploring.
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Arsenic trioxide as effective therapy for relapsed acute promyelocytic leukemia.
Mayorga, J, Richardson-Hardin, C, Dicke, KA
Clinical journal of oncology nursing. 2002;(6):341-6
Abstract
The standard of treatment for newly diagnosed patients with acute promyelocytic leukemia (APL) is all-trans retinoic acid (ATRA) plus anthracycline-based cytotoxic chemotherapy, a combination that is highly effective for remission induction. However, 20%-30% of patients relapse and require salvage therapy. Reports from China on the striking efficacy and safety of arsenic trioxide in patients with APL led to clinical trials in the United States, which culminated in U.S. Food and Drug Administration approval in September 2000. Trisenox (Cell Therapeutics, Inc., Seattle, WA) is an injectable formulation of arsenic trioxide indicated in the treatment of refractory or relapsed APL. The common side effects of Trisenox therapy are mostly mild and self-limiting and do not require interruption of therapy. Serious adverse effects that can occur include hyperleukocytosis, electrocardiographic abnormalities, and APL differentiation syndrome. These effects can be prevented or managed successfully with careful patient monitoring during treatment. Trisenox has no known cross-resistance with ATRA or other anticancer agents. It does not cause hair loss and is not myelosuppressive in patients with APL. Oncology nurses can play a major role in educating patients about this new drug, explaining its clinical benefits and side effects and the precautions that are necessary for its use.