title: Differentiation syndrome in patients with acute promyelocytic leukemia.
abstract: OBJECTIVE
  To review the pathophysiology, risk factors, and management of differentiation syndrome (DS) associated with acute promyelocytic leukemia (APL).
  
  
  METHODS
  A MEDLINE search was conducted (1977-November 2010) using the terms APL, DS, all-trans retinoic acid (ATRA), retinoic acid syndrome, and arsenic trioxide (ATO).
  
  
  METHODS
  English articles identified from the MEDLINE search were evaluated.
  
  
  METHODS
  With ATRA, ATO, and chemotherapy, a complete remission is achievable for most newly diagnosed APL patients. However, treatment with the differentiating agents, ATRA and ATO, can lead to the development of DS. Signs and symptoms of this syndrome include hyperleukocytosis and cardiorespiratory compromise. Severe complications can develop, if DS is not recognized early and treated promptly with corticosteroids. In addition, patients with a high white blood cell count at diagnosis may benefit from prophylactic steroids.
  
  
  CONCLUSIONS
  Early recognition and prompt initiation of corticosteroids are key factors in the management of DS. Healthcare professionals need to be familiar with this complication which can arise from differentiation agents.
authors.affiliation: UT MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Rogers
authors.forename: Daisy
authors.initials: D
authors.lastname: Yang
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects / Q000627:therapeutic use; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D007958:Leukocyte Count; D010087:Oxides / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013577:Syndrome; D013997:Time Factors; D014212:Tretinoin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D005938:Glucocorticoids; D010087:Oxides; D014212:Tretinoin; D000077237:Arsenic Trioxide