Acute Promyelocytic Leukemia Patients Receiving ATRA with and without Voriconazole Prophylaxis: Effect on Incidence and Outcomes of Differentiation Syndrome.

Background: The combination of all trans-retinoic acid (ATRA) and voriconazole may lead to increased ATRA exposure resulting in a higher incidence of differentiation syndrome (DS). Patients and Methods: This single center analysis evaluated the incidence and outcomes of ATRA-induced DS in 46 adult patients with acute promyelocytic leukemia (APL) undergoing induction chemotherapy. Results: Thirty-one patients (69% by day 60) received a chemotherapy regimen including ATRA coinciding with voriconazole administration and 15 patients underwent treatment without voriconazole. The overall incidence of DS was 36% (n=16) by day 60, with patients receiving voriconazole showing a trend towards a higher incidence (HR 2.31, CI 0.78-6.847, p=0.1308). This trend persisted after adjusting for BMI (HR 1.96, CI 0.65-5.94, p=0.23); however, a small number of DS events precluded statistical significance. Conclusion: A trend towards an increased incidence and severity of ATRA-mediated DS was seen in adult APL patients receiving voriconazole prophylaxis during induction chemotherapy. This important finding warrants validation in larger studies.

Thrombotic microangiopathies presenting as an obstetric emergency.

Thrombotic microangiopathies are disorders that arise due to a diffuse endothelial damage. They predominantly manifest either as thrombotic trombocytopenic purpura (TTP) or hemolytic uremic syndrome (HUS). When they arise as a complication of pregnancy and associated disorders they are associated with a high mortality and morbidity.