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Review
. 2019 Oct;187(2):157-162.
doi: 10.1111/bjh.16151. Epub 2019 Aug 13.

Differentiation syndrome in acute promyelocytic leukaemia

Maximilian Stahl  1   2 , Martin S Tallman  1   2
Affiliations
Review

Differentiation syndrome in acute promyelocytic leukaemia

Maximilian Stahl et al. Br J Haematol. 2019 Oct.

Abstract

Acute promyelocytic leukaemia differentiation syndrome (APL DS) is seen when patients with APL are treated with all-trans retinoic acid (ATRA) and/or arsenic trioxide (ATO). Presenting symptoms are varied but frequently include dyspnoea, unexplained fever, weight gain >5 kg, unexplained hypotension, acute renal failure and a chest radiograph demonstrating pulmonary infiltrates or pleural or pericardial effusion. Immediate treatment with steroids at the first clinical suspicion is recommended and ATRA/ATO should be stopped in severe cases or if there is no response to treatment. The utility of steroid prophylaxis in order to prevent APL DS is less certain. Here we provide a detailed review of the pathogenesis, clinical signs and symptoms as well as management and prophylaxis strategies of APL DS.

Keywords: acute promyelocytic leukaemia; all-trans retinoic acid; arsenic trioxide; differentiation syndrome; retinoid acid syndrome.

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