Differentiation syndrome in acute promyelocytic leukaemia

• Published in: British journal of haematology Vol. 187; no. 2; pp. 157 - 162
• Main Authors: Stahl, Maximilian, Tallman, Martin S.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-10-2019
• Subjects: acute promyelocytic leukaemia; all‐trans retinoic acid; Arsenic; Arsenic trioxide; differentiation syndrome; Dyspnea; Effusion; Fever; Hematology; Hypotension; Leukemia; Pathogenesis; Prophylaxis; Renal failure; Respiration; Retinoic acid; retinoid acid syndrome; Steroid hormones; Steroids; Tretinoin; all-trans retinoic acid; arsenic trioxide; differentiation syndrome; acute promyelocytic leukaemia; retinoid acid syndrome
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.16151

Summary
Acute promyelocytic leukaemia differentiation syndrome (APL DS) is seen when patients with APL are treated with all‐trans retinoic acid (ATRA) and/or arsenic trioxide (ATO). Presenting symptoms are varied but frequently include dyspnoea, unexplained fever, weight gain >5 kg, unexplained hypotension, acute renal failure and a chest radiograph demonstrating pulmonary infiltrates or pleural or pericardial effusion. Immediate treatment with steroids at the first clinical suspicion is recommended and ATRA/ATO should be stopped in severe cases or if there is no response to treatment. The utility of steroid prophylaxis in order to prevent APL DS is less certain. Here we provide a detailed review of the pathogenesis, clinical signs and symptoms as well as management and prophylaxis strategies of APL DS.