ABSTRACT
OBJECTIVE: To describe the retinoic acid syndrome, a complication of therapy with all-trans retinoic acid (ATRA) in acute promyelocitic leukemia (APL). PATIENTS AND METHODS: Retrospective study of five patients with a morphologic diagnosis of APL by the French-American-British (FAB) classification that were treated for remission induction with ATRA and developed the ATRA syndrome. RESULTS: Three patients in newly diagnosed APL and two in leukemia relapse were analyzed. All patients received with ATRA 45 mgrs/m2/day, and three of them also received chemotherapy. Patients developed fever, respiratory distress, pulmonary infiltrates, weight gain and edemas. The onset of this symptom complex occurred from 1 to 11 days after starting treatment and was preceded by an increased in peripheral blood leukocytes. Infections or congestive heart failure were ruled out. The clinical course progressed while patients being treated with wide spectrum antibiotics. Four patients were treated with high doses corticosteroid therapy (dexametasone 10 mgrs intravenously every 12 hours), in three of them full recovery was attained and one died. One patient that did not received steroids died. CONCLUSIONS: The use of all-trans retinoic acid to induce hematologic remission in APL patients is associated in same patients with the development of ATRA syndrome, a life threatening complication. Symptoms begin in the first days of treatment. If this syndrome is suspected, early treatment with high dose steroids should be initiated.
Subject(s)
Antineoplastic Agents/adverse effects , Leukemia, Myeloid, Acute/drug therapy , Lung Diseases, Interstitial/chemically induced , Respiratory Insufficiency/chemically induced , Tretinoin/adverse effects , Adolescent , Female , Humans , Male , Middle Aged , Pulmonary Edema/chemically induced , Retrospective Studies , SyndromeABSTRACT
Objetivo: Describir el síndrome del ATRA como complicación del tratamiento con ácido todo-trans-retinoico (ATRA) o tretinoino, en la leucemia promielocítica aguda (LPA).Métodos: Estudio retrospectivo, incluyendo cinco pacientes diagnosticados de LPA según los criterios FAB, que recibieron tratamiento de inducción con ATRA y desarrollaron en su evolución el Síndrome del ATRA.Resultados: Tres pacientes fueron tratados al diagnóstico y dos en la recidiva leucémica. Todos ellos recibieron ATRA, 45 mg/m2/día por vía oral en pauta continua, acompañado en tres casos de quimioterapia convencional. Entre el día +1 y el día +11 desde el inicio del tratamiento, los pacientes desarrollaron fiebre, insuficiencia respiratoria con infiltrados pulmonares, ganancia de peso y edemas. El inicio del cuadro fue precedido de leucocitosis en todos los casos. Se descartaron infeccion e insuficiencia cardíaca. La clínica progresó en el contexto de amplia cobertura antibiótica. Cuatro pacientes recibieron tratamiento con dexametasona endovenosa (10 mg/12 horas), de los cuales tres evolucionaron favorablemente y uno falleció. El paciente que no se trató falleció.Conclusión: El síndrome del ATRA es una complicación potencialmente mortal en pacientes con LPA que reciben tratamiento de inducción con ATRA. Habitualmente aparece a los pocos días del inicio del tratamiento. Ante la sospecha de este cuadro clínico debe establecerse tratamiento precoz con esteroides en dosis altas. (AU)
Subject(s)
Middle Aged , Adolescent , Male , Female , Humans , Tretinoin , Syndrome , Respiratory Insufficiency , Pulmonary Edema , Retrospective Studies , Antineoplastic Agents , Leukemia, Myeloid, Acute , Lung Diseases, InterstitialABSTRACT
Neurological complications caused by varicella-zoster virus, excluding post-herpetic neuralgia and aseptic meningitis, are infrequent and varied. Other complications, which have been described are peripheral motor neuropathy, cranial nerve palsies, meningoencephalitis, Guillain-Barré syndrome, myelitis, herpes zoster ophthalmicus with delayed contralateral hemiparesis and Reye syndrome. We present 4 patients with infrequent neurological complications associated with varicella-zoster virus: 3 cases of meningoencephalitis and one case of myelitis.
