Diffuse alveolar hemorrhage in acute promyelocytic leukemia patients treated with ATRA--a manifestation of the basic disease or the treatment.
All-trans-retinoic acid (ATRA) is considered the recommended induction treatment for acute promyelocytic leukemia. In the pre-ATRA era pulmonary bleeding was a common cause of death in these patients, mostly due to disseminated intravascular coagulation which was further exacerbated by the administration of chemotherapy. Although ATRA syndrome, the most serious adverse effect of ATRA treatment, involves the lungs, pulmonary hemorrhage has only rarely been reported as a manifestation of ATRA syndrome. Here we describe 2 patients who developed diffuse alveolar hemorrhage during treatment with ATRA. The possible mechanisms of pulmonary bleeding in these cases are discussed.
Raanani
P
P
Institute of Hematology, The Chaim Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Israel. praanani@netvision.net.il
Segal
E
E
Levi
I
I
Bercowicz
M
M
Berkenstat
H
H
Avigdor
A
A
Perel
A
A
Ben-Bassat
I
I
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001780:Blood Coagulation Tests; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D004417:Dyspnea / Q000139:chemically induced; D017809:Fatal Outcome; D005334:Fever / Q000139:chemically induced; D006470:Hemorrhage / Q000139:chemically induced / Q000209:etiology*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications / Q000188:drug therapy*; D008171:Lung Diseases / Q000139:chemically induced / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000187:drug effects; D012074:Remission Induction; D013577:Syndrome; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
D000970:Antineoplastic Agents; D003561:Cytarabine; D014212:Tretinoin; D003630:Daunorubicin