Massive ascites associated with all-trans retinoic acid treatment in therapy-related acute promyelocytic leukemia.
A 77-year-old man who developed pancytopenia was administered granulocyte colony-stimulating factor (G-CSF) by another doctor, and referred to us for the evaluation of pancytopenia. He had hepatocellular carcinoma and was treated with transcatheter arterial chemoembolization (TACE) containg epirubicin (total dose: 300 mg over the last two years). Bone marrow aspiration smear demonstrated hypercellular marrow with promyelocytes. Cytogenetic analysis demonstrated del(7), t(15;17)(q22;q12), and a fluorescence in-situ hybridization (FISH) study demonstrated chimeric fusion genes of PML-RAR-alpha. He was diagnosed with therapy-related acute promyelocytic leukemia (APL), and treated with all trans-retinoic acid (ATRA). He showed the progressive accumulation of ascites with liver damage, without pulmonary symptoms of ATRA differentiation syndrome. After 60 days of ATRA treatment, complete hematological and cytogenetic responses were achieved. However, the patient died of septic circulatory failure.
Suzukawa
Munehiro
M
Division of Hematology, Department of Medicine, Yamaguchi Prefectural Medical Center, Hofu.
Nakazora
Tatsuki
T
Kawasaki
Yasufumi
Y
Tominaga
Takayuki
T
Shinohara
Kenji
K
D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001201:Ascites / Q000139:chemically induced* / Q000175:diagnosis*; D006528:Carcinoma, Hepatocellular / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D015251:Epirubicin / Q000008:administration & dosage; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000209:etiology*; D008113:Liver Neoplasms / Q000628:therapy; D008297:Male; D014212:Tretinoin / Q000009:adverse effects* / Q000627:therapeutic use*
D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D015251:Epirubicin; D014212:Tretinoin