Retinoic acid syndrome after first dose of ATRA and ileal perforation secondary to promyelocytes infiltration

Differentiation Syndrome with Severe Abdominal Pain During Induction Treatment of Acute Promyelocytic Leukemia: A Case Report

Background

Acute promyelocytic leukemia differentiation syndrome (APL DS) is a common and severe complication seen in patients with APL treated with all-trans retinoic acid (ATRA) and/or arsenic trioxide (ATO). The presenting symptoms of APL DS are diverse, and rare symptoms are easy to be misdiagnosed. Therefore, it is very crucial to identify DS from uncommon signs to avoid delay in treatment.

Case Presentation

Here, we report a patient of APL who developed severe abdominal pain during ATRA and ATO therapy, with increasing leukocyte count. Organic diseases were firstly excluded, and empiric treatment for DS was adopted. The abdominal pain was gradually relieved and the patient eventually achieved complete remission.

Conclusion

This case history suggests that APL DS may manifest as severe abdominal pain, and the early identification of DS and immediate treatment could improve the prognosis of patients.

Multiple adverse drug reactions during all-trans retinoic acid treatment for acute promyelocytic leukemia: differentiation syndrome, bradycardia, intestinal necrosis

All-trans retinoic acid (ATRA) induces complete remission in a high proportion of acute promyelocytic leukemia (APL). Nevertheless it is be associated with adverse drug reactions that might be life-threatening including differentiation syndrome, myocarditis, myositis, Sweet’s syndrome and ulcers. We describe a case of APL who during induction therapy developed ATRA syndrome, cardiac arrhythmia and multiple episodes of intestinal necrosis that required surgery. In particular, we report here for the first intestinal necrosis attributable to ATRA treatment in the absence of histological evidence of promyelocytes infiltration or leukocytoclastic vasculitis.

Leukemia in gastrointestinal organs as cause of treatment failure: 378 cases analyzed

Leukemia growing as tumors in gastrointestinal organs is an under-investigated cause of treatment failure and death. These present with symptoms often mistaken for common toxicities but may grow large before symptoms. To synthesize experience available only in case reports, 378 were analyzed. Invasive and metastatic behavior typical of solid GI tumors was revealed even when marrow was uninvolved. Within 3 months of diagnosis, 33% had died, 47% within 1 year. Survivals of 4 to 18 years after involvement suggest cure is possible. Evidence is presented that combined local and systemic therapy has successfully treated GI leukemic tumors when identified early.