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). Data source. 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 of study selection. English articles identified from the MEDLINE search were evaluated. Data extraction and synthesis. 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.