Pulmonary leukostasis secondary to all-trans retinoic acid in the treatment of acute promyelocytic leukemia in first relapse.
All-trans retinoic acid has recently been shown to induce differentiation of acute promyelocytic leukemia cells in vitro and in vivo. Clinical trials of patients treated de novo, in first relapse, and with resistant disease have achieved a high rate of complete remission (CR). The overall toxicity is substantially less than standard induction chemotherapy, with the notable exception of deaths attributed to the development of pulmonary leukostasis coinciding with a rapid increase in the number of mature neutrophils. This report describes a patient who developed pulmonary leukostasis in the absence of significant leukocytosis. The patient survived pulmonary leukostasis, resumed therapy, and achieved a CR. The case demonstrates features of leukostasis which are peculiar to the 'retinoic acid syndrome'.
Vosburgh
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Department of Medicine, Boston University School of Medicine, MA 02118.
D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000473:pathology; D007962:Leukocytes / Q000473:pathology*; D008171:Lung Diseases / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D014212:Tretinoin / Q000009:adverse effects* / Q000627:therapeutic use
D014212:Tretinoin