Late-onset differentiation syndrome in a child with acute promyelocytic leukemia

Excerpt

All-trans retinoic acid (ATRA) improves the outcome of patients with acute promyelocytic leukemia (APL) [1, 2]. ATRA administration leads to complete remission in APL patients by inducing growth arrest and differentiation of the leukemic clone. Caution is needed during ATRA treatment because of the potential development of differentiation syndrome (DS), formerly known as retinoic acid syndrome. It is a cardiorespiratory syndrome characterized by unexplained fever, weight gain, respiratory distress, interstitial pulmonary infiltrates, pleural and pericardial effusions, acute renal failure, cardiac failure, and hypotension [3, 4]. Although this syndrome commonly develops during the first week after starting ATRA treatment [3, 4], late-onset DS has been observed in a substantial number of patients [4]. We report a child with APL who developed DS after 21 days on ATRA treatment. …