[Hematological features and expression profile of myeloid antigens of acute promyelocytic leukemia patients: analysis of prognostic factors for development of the retinoic acid syndrome].
BACKGROUND
Acute Promyelocytic Leukemia (APL) is characterized by its good response to treatment with all trans retinoic acid (ATRA). However, some patients receiving ATRA develop a serious complication called retinoid syndrome (RS). The objective of this study was to compare the hematological and immunophenotypic features of APL patients who developed RS with those who did not.


METHODS
We reviewed the medical records, roentgenograms, peripheral blood smears and bone marrow aspirates from 71 APL patients. Immunophenotypic analyses were available in 56 of these cases. Eight cases of RS were detected, whose clinical presentation was characterized by respiratory distress (n = 8), impairment of the renal function (n = 2), fever (n = 5), weight gain (n = 3), edema (n = 3) and/or pleural effusion (n = 5). The following variables were compared in patients with and without RS: hemoglobin levels, leukocyte and platelet counts, frequency of hypergranular and variant morphological subtypes, percentages of CD33+, CD13+, CD117+ blasts in the bone marrow, fluorescence intensity and variation of these markers in the leukemic cells, expressed as the median channel of fluorescence (MCF) and fluorescence coefficient of variation (CV), respectively.


RESULTS
RS incidence was 11.26% and the average time for syndrome development was 11.5 days after starting ATRA treatment. All patients presented acute respiratory distress. Other symptoms included fever, weight gain, edema and renal insufficiency. The main radiological findings were ground glass opacities, increased vascular pedicle and peribronchial cuffing. There was no significant correlation between the variables selected and the risk of development of RS, however the Odds Ratios for patients presenting MCF for CD117 > 30 ua and CV for CD33 < 50 were of 7.14 (P = 0.08) and 7.86 (P = 0.06), respectively.


CONCLUSIONS
The incidence, as well as the clinical, radiological and laboratory features of RS in this group of Brazilian APL patients were similar to those described in literature. None of the variables studied were significantly correlated to a higher risk of developing RS.
Santos
Flávia Leite Souza
FL
Divisões de Hematologia e de Diagnóstico por Imagem, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, SP.
Dore
Adriana I
AI
Lima
Ana Sílvia G
AS
Garcia
Aglair B
AB
Zago
Marco A
MA
Rizzatti
Edgar G
EG
Elias
Jorge
J
Falcão
Roberto Passetto
RP
Rego
Eduardo Magalhães
EM
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D015473:Leukemia, Promyelocytic, Acute / Q000097:blood / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011379:Prognosis; D017678:Sex Distribution; D013577:Syndrome; D014212:Tretinoin / Q000009:adverse effects*
D000970:Antineoplastic Agents; D014212:Tretinoin