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acute promyelocytic leukemia renal failure

Sabine Kayser, Richard F Schlenk, Uwe Platzbecker
With the introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) acute promyelocytic leukemia (APL) has become from a detrimental to one of the most curable malignant diseases in humans. In particular, the chemotherapy-free regimen with ATO/ATRA has been proven to be highly effective in de novo APL and has become standard first-line therapy in younger adult, non-high-risk patients. Nevertheless, early death is still a major issue in APL, particularly in older patients, emphasizing the need of rapid diagnostics and supportive care together with immediate access to ATRA-based therapy...
April 24, 2018: Leukemia: Official Journal of the Leukemia Society of America, Leukemia Research Fund, U.K
Serdal Korkmaz
Hyperleukocytosis is defined as a white blood cell count greater than 100.000/μL in patients affected by acute or chronic leukemias. Hyperleukocytosis is more common in acute leukemias than in chronic leukemias. Risk factors include younger age, acute myeloid leukemia, the microgranular variant of acute promyelocytic leukemia, acute lymphoblastic leukemia and some cytogenetic abnormalities. Although it can affect any organ system, symptoms usually arise from involvement of the cerebral, pulmonary and renal microvasculature...
February 2018: Transfusion and Apheresis Science
Chang Hoon Ahn, Seung-A Han, Young Hwa Kong, Sun Jun Kim
PURPOSE: The aim of this study was to assess the clinical characteristics of hypertensive encephalopathy according to the underlying etiologies in children. METHODS: We retrospectively evaluated 33 pediatric patients who were diagnosed as having hypertensive encephalopathy in Chonbuk National University Children's Hospital. Among the patients, 18 were excluded because of incomplete data or because brain magnetic resonance imaging (MRI) was not performed. Finally, 17 patients were enrolled and divided into a renal-origin hypertension group and a non-renal-origin hypertension group according to the underlying cause...
August 2017: Korean Journal of Pediatrics
Arturo J Martí-Carvajal, Vidhu Anand, Ivan Solà
BACKGROUND: Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by systemic intravascular activation of coagulation, leading to deposition of fibrin in the bloodstream. It may occur in patients with acute and chronic leukemia and is particularly associated with acute promyelocytic leukemia (a subtype of acute myeloid leukemia). OBJECTIVES: To assess the clinical benefits and harms of any pharmacological intervention for treating DIC in patients with acute or chronic leukemia...
June 24, 2015: Cochrane Database of Systematic Reviews
Luciano Cardinale, Francesco Asteggiano, Federica Moretti, Federico Torre, Stefano Ulisciani, Carmen Fava, Giovanna Rege-Cambrin
In acute promyelocytic leukemia, differentiation therapy based on all-trans-retinoic acid can be complicated by the development of a differentiation syndrome (DS). DS is a life-threatening complication, characterized by respiratory distress, unexplained fever, weight gain, interstitial lung infiltrates, pleural or pericardial effusions, hypotension and acute renal failure. The diagnosis of DS is made on clinical grounds and has proven to be difficult, because none of the symptoms is pathognomonic for the syndrome without any definitive diagnostic criteria...
August 28, 2014: World Journal of Radiology
Miguel A Sanz, Pau Montesinos
Differentiation syndrome (DS), formerly known as retinoic acid syndrome, is a relatively common and potentially severe complication seen in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and/or arsenic trioxide. The full-blown syndrome consists of unexplained fever, weight gain, dyspnea with pulmonary infiltrates, pleuropericardial effusion, hypotension, and renal failure. Most measures currently used for management of DS have very little evidence-based support, and therefore, many remain controversial...
May 1, 2014: Blood
Julia Riganti, Mariana P Caviedes, Ana C Torre, Mariana Guzzi Maqueda, Maria C Baztan Piñero, Victoria I Volonteri, Ricardo L Galimberti
BACKGROUND: All-trans retinoic acid (ATRA) is routinely associated with chemotherapy for the treatment of acute promyelocytic leukemia (APL). Several reports of scrotal ulceration induced by this agent have been made in the recent years. AIMS: The aim of this article was to report the first case of a lingual ulceration associated with retinoic acid syndrome (RAS). MATHERIALS AND METHODS: We presented a 32-year-old man with a diagnosis of acute promyelocytic leukemia who received treatment with ATRA...
July 2014: International Journal of Dermatology
Manuel Polaina-Rusillo, Maria del Pilar Pérez-del Barrio, Ana Maria Carrillo-Colmenero, César Ramírez-Tortosa, Josefa Borrego-Hinojosa, Antonio Liébana-Cañada
A 37-year-old patient was transferred to Haematology from the ENT Emergency Department where he had been admitted due to tonsillitis. He displayed anaemia and leukopenia and had agranulocytosis in the study. A day later the patient had blast crisis, and was diagnosed with myeloid acute leukaemia. Due to blast crisis the patient experienced sudden back pain, with oliguria and renal function deterioration followed by anaemia, in the context of haemolysis consistent with thrombotic microangiopathy, and as such, we were consulted...
November 13, 2013: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Zeeshan Tariq, Richard C Phinney, Iman Mohamed
All-trans-retinoic acid represents a major progress that has made acute promyelocytic leukemia the most curable subtype of acute myeloid leukemia in adults. Although all-trans-retinoic acid is usually well tolerated, some patients develop the retinoic acid syndrome, characterized by unexplained fever, weight gain, respiratory distress, interstitial pulmonary infiltrates, pleural and pericardial effusions, episodic hypotension, and acute renal failure. Further studies of growth factor expression and modulation of adhesion molecules are warranted to provide further insights into the pathogenesis of the syndrome and may lead to its prevention...
March 2014: American Journal of Therapeutics
Gregory S Emmons, Richard H Steingart, James A Stewart, Wilson C Mertens
UNLABELLED: HASH(0x37c3ae8) INTRODUCTION: In the relapsed setting, arsenic trioxide remains the backbone of treatment. Scant literature exists regarding treatment of relapsed acute promyelocytic leukemia in patients with renal failure. To the best of our knowledge we are the first to report a safe and effective means of treatment for relapsed acute promyelocytic leukemia in the setting of advanced renal failure, employing titration of arsenic trioxide based on clinical parameters rather than arsenic trioxide levels...
2012: Journal of Medical Case Reports
Saime Paydas, Semra Paydas, Mustafa Balal
Acute leukemia has been reported as secondary to radiation therapy in patients with ankylosing spondylitis (AS). AA amyloidosis secondary to AS causes progressive organ failure. Although new therapeutic choices can be used, response to therapy in secondary amyloidosis is not good enough. In AA amyloidosis, clinical symptoms partially regress with colchicine. Here, we report a patient with acute leukemia and AS. After complete remission of acute leukemia, pulmonary tuberculosis, acute renal failure and nephrotic syndrome developed...
July 2013: American Journal of Therapeutics
Hyun Ji Chun, Su Jeong Kim, In O Sun, Byung Ha Chung, Ji-Il Kim, In Sung Moon, Woo-Sung Min, Chul Woo Yang
In general, a 2-yr disease-free duration is recommended before kidney transplantation (KT) in end-stage renal disease (ESRD) patients who also have acute leukemia. However, the optimal disease-free interval has not been specified for all subtypes of acute leukemia. Among these subtypes, acute promyelocytic leukemia (APL) shows a favorable prognosis and low relapse rate compared to other types of leukemia. We here report KT after complete remission (CR) of APL in an ESRD patient. Irreversible kidney injury developed in a 23-yr-old man with APL...
July 2012: Journal of Korean Medical Science
Takashi Ushiki, Koji Nikkuni, Chie Yoshida, Yasuhiko Shibasaki, Toru Ishikawa, Masayoshi Masuko, Kazue Takai
A 35-year-old man admitted to the hospital for oral hemorrhage was diagnosed with acute promyelocytic leukemia (APL). Remission from APL was achieved by induction therapy with all-trans retinoic acid (ATRA); the PML/RARA fusion gene was not detected on PCR analysis. Despite complete molecular remission, severe persistent pancytopenia, massive ascites, and renal failure were observed. The liver surface appeared rough and irregular on computed tomographic images. On the basis of the liver biopsy results, we diagnosed his condition as portal hypertension due to autoimmune hepatitis...
January 2012: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
Pau Montesinos, Miguel A Sanz
Differentiation syndrome (DS), formerly known as retinoic acid syndrome, is the main life-threatening complication of therapy with differentiating agents (all-trans retinoic acid [ATRA] or arsenic trioxide [ATO]) in patients with acute promyelocytic leukemia (APL). The differentiation of leukemic blasts and promyelocytes induced by ATRA and/or ATO may lead to cellular migration, endothelial activation, and release of interleukins and vascular factors responsible of tissue damage. Roughly one quarter of patients with APL undergoing induction therapy will develop the DS, characterized by unexplained fever, acute respiratory distress with interstitial pulmonary infiltrates, and/or a vascular capillary leak syndrome leading to acute renal failure...
2011: Mediterranean Journal of Hematology and Infectious Diseases
E M Rego, G C De Santis
Differentiation syndrome (DS) represents a life-threatening complication in patients with acute promyelocytic leukemia (APL) undergoing induction therapy with all-trans retinoic acid (ATRA) or arsenic trioxide (ATO). It affected about 20-25% of all patients and so far there are no definitive diagnostic criteria. Clinically, DS is characterized by weight gain, fever not attributable to infection, respiratory distress, cardiac involvement, hypotension, and/or acute renal failure. At the histological point of view, there is an extensive interstitial and intra-alveolar pulmonary infiltration by maturing myeloid cells, endothelial cell damage, intra-alveolar edema, inter-alveolar hemorrhage, and fibrinous exsudates...
2011: Mediterranean Journal of Hematology and Infectious Diseases
Gelcimar Moresco, Flávia Martinello, Liliete Canes Souza
This is a report of the case of a patient with acute promyelocytic leukemia treated with all trans-retinoic acid (ATRA), who had suspected all-trans retinoic acid syndrome (ATRA syndrome). The nonspecific febrile leukopenia observed justified the association with antimicrobial and antifungal therapy. Signs and symptoms contributed to the suspicion of ATRA syndrome, and renal function was impaired by the combination with antifungal agents. The decrease in renal function observed initially contributed to the suspicion of ATRA syndrome and was aggravated by antifungals...
April 2011: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Yoshiki Tsuchiya, Yoshifumi Ubara, Tatsuya Suwabe, Junichi Hoshino, Keiichi Sumida, Rikako Hiramatsu, Eiko Hasegawa, Masayuki Yamanouchi, Noriko Hayami, Yuji Marui, Naoki Sawa, Fumi Takemoto, Kenmei Takaichi
Acute promyelocytic leukemia (APL) has the best prognosis among acute leukemias, but there is little data about APL in patients on hemodialysis. A 64-year-old hemodialysis patient was successfully treated for APL by induction therapy with all-trans retinoic acid (ATRA), three courses of consolidation therapy with Ara-C, mitomycin C (MIT), daunorubicin (DNR), and idarubicin (IDR), and maintenance therapy with ATRA. Complete remission has been maintained for 42 months in this patient. With dose modification, ATRA and chemotherapy may be safely given to patients on hemodialysis...
June 2011: Clinical and Experimental Nephrology
Arito Yamane, Norifumi Tsukamoto, Takayuki Saitoh, Hideki Uchiumi, Hiroshi Handa, Masamitsu Karasawa, Yoshihisa Nojima, Hirokazu Murakami
Although all-trans retinoic acid (ATRA) is widely used in acute promyelocytic leukemia (APL), there is little data as to whether or not ATRA is useful for patients with liver and renal failure. A 63-year-old APL patient, complicated by Child-Pugh class A liver cirrhosis and chronic renal failure (creatinine 3.2 mg/dL), was successfully treated with 45 mg/m(2)/day of ATRA. With three courses of chemotherapy, complete remission has been maintained for four years in this patient. Serum trough and maximum ATRA concentration, and the area under the curve (AUC) were not elevated...
2009: Internal Medicine
Shahid Raza, Khalil Ullah, Parvez Ahmed, Badshah Khan
OBJECTIVE: To compare survival in Acute Promyelocytic Leukemia (APL) patients treated with or without All-Trans Retinoic Acid (ATRA). STUDY DESIGN: Longitudinal, comparative study. PLACE AND DURATION OF STUDY: The Armed Forces Bone Marrow Transplant Centre (AFBMTC), Rawalpindi, Pakistan from May 2001 to April 2007. METHODOLOGY: All consecutive newly diagnosed patients of acute promyelocytic leukemia, treated at Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan, between May 2001 and April 2007, were included and given chemotherapy according to availability of ATRA...
September 2008: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Richard Cashin, Lisa Burry, Kenneth Peckham, Stuart Reynolds, Jack T Seki
PURPOSE: The case of a patient who developed acute renal failure, gastrointestinal bleeding, and cardiac arrhythmia after receiving arsenic trioxide for the treatment of acute promyelocytic leukemia (APL) is described. SUMMARY: An 84-year-old Caucasian woman with a history of osteoarthritis sought medical attention for relapse of her APL, which had initially been diagnosed approximately 30 months earlier. Complete remission was accomplished with three cycles of i...
May 15, 2008: American Journal of Health-system Pharmacy: AJHP
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