Leukocytosis and retinoic acid syndrome in patients with acute promyelocytic leukemia treated with arsenic trioxide.
OBJECTIVE
To study the incidence of leukocytosis and retinoic acid (RA) syndrome in newly diagnosed and relapsed acute promyelocytic leukemia (APL) patients treated with arsenic trioxide (ATO).


METHODS
Thirty patients with newly diagnosed or relapsed APL received ATO for remission induction at the dose of 10 mg/d. RA syndrome was defined when patient was with one or more of the following signs or symptoms: fever, dyspnea, serous cavity effusion, muscular pain, pulmonary infiltration, weight gain, or pulmonary infiltration on chest X-ray.


RESULTS
Twenty-three (77% ) patients achieved complete remission, mean time to remission was 37.1 days. Leukocytosis was observed in 14 (47%) patients, mean time to leukocytosis was 12.7 days, median baseline leukocyte count for patients with leukocytosis was 3.1 x 10(9)/L, which was higher than that for patients who did not develop leukocytosis (2.6 x 10(9)/L, z = -2.635, P = 0.008). No other cytotoxic therapy was administered, and the leukocytosis resolved in all cases. The RA syndrome was observed in 9 (30%) patients, mean time to diagnose of RA syndrome was 13.9 days, median baseline leukocyte count for patients with RA syndrome was 3.6 x 10(9)/L, which was higher than that for patients who did not develop RA syndrome (2.6 x 10(9)/L, z = -1.909, P = 0.046). No patient died of RA syndrome.


CONCLUSIONS
Leukocytosis and RA syndrome are associated with ATO and baseline leukocyte count respectively, and there is distinct link between leukocytosis and RA syndrome.
Jin
Bo
B
Department of Medical Oncology, the First Affiliated Hospital, China Medical University, Shenyang 110001. jinbo@csco.org.cn
Hou
Ke-zuo
KZ
Liu
Yun-peng
YP
Yu
Ping
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects* / Q000627:therapeutic use; D004417:Dyspnea / Q000139:chemically induced; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D007958:Leukocyte Count; D007964:Leukocytosis / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000009:adverse effects* / Q000627:therapeutic use; D012074:Remission Induction; D013577:Syndrome
D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D000077237:Arsenic Trioxide