title: [Very Severe Differentiation Syndrome in Low Risk Acute Promyelocytic Leukemia - A Peril of Differentiating Therapy].
abstract: History, examinations and diagnosisA young patient consulted the hospital because of spontaneous hematomas. The combination of pancytopenia and coagulopathy in the blood and the proving cytogenetic and moleculargenetic examinations of the bone marrow lead to the diagnosis of low-risk acute promyelocytic leukemia (APL).Therapy and clinical courseDuring the combination therapy with ATRA and ATO, the patient developed a severe differentiation syndrome and hyperleukocytosis. Management of the condition was only possible due to clinical expertise and massive substitution of blood products and clotting factors.ConclusionThe case illustrates the difficulty and dangers of APL induction therapy even with a favorable initial clinical presentation despite the generally low toxicity of new therapies.
authors.affiliation: Universitätsmedizin Mannheim, III. Medizinische Klinik, Hämatologie und internistische Onkologie, Mannheim.
authors.forename: Anna
authors.initials: A
authors.lastname: Hecht
authors.affiliation: St. Vincentius Kliniken, Abteilung für Hämatologie, Onkologie, Immunologie und Palliativmedizin, Karlsruhe.
authors.forename: Joerg
authors.initials: J
authors.lastname: Mezger
authors.affiliation: St. Vincentius Kliniken, Abteilung für Hämatologie, Onkologie, Immunologie und Palliativmedizin, Karlsruhe.
authors.forename: Martina
authors.initials: M
authors.lastname: Gnadler
authors.affiliation: Universitätsmedizin Mannheim, III. Medizinische Klinik, Hämatologie und internistische Onkologie, Mannheim.
authors.forename: Eva
authors.initials: E
authors.lastname: Lengfelder
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000008:administration & dosage / Q000009:adverse effects; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D005260:Female; D005334:Fever / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D007964:Leukocytosis / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D008171:Lung Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D010087:Oxides / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D012720:Severity of Illness Index; D013577:Syndrome; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D014212:Tretinoin; D000077237:Arsenic Trioxide