Retinoic acid syndrome

WikiDoc Resources for Retinoic acid syndrome
Articles
Most recent articles on Retinoic acid syndrome Most cited articles on Retinoic acid syndrome Review articles on Retinoic acid syndrome Articles on Retinoic acid syndrome in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Retinoic acid syndrome Images of Retinoic acid syndrome Photos of Retinoic acid syndrome Podcasts & MP3s on Retinoic acid syndrome Videos on Retinoic acid syndrome
Evidence Based Medicine
Cochrane Collaboration on Retinoic acid syndrome Bandolier on Retinoic acid syndrome TRIP on Retinoic acid syndrome
Clinical Trials
Ongoing Trials on Retinoic acid syndrome at Clinical Trials.gov Trial results on Retinoic acid syndrome Clinical Trials on Retinoic acid syndrome at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Retinoic acid syndrome NICE Guidance on Retinoic acid syndrome NHS PRODIGY Guidance FDA on Retinoic acid syndrome CDC on Retinoic acid syndrome
Books
Books on Retinoic acid syndrome
News
Retinoic acid syndrome in the news Be alerted to news on Retinoic acid syndrome News trends on Retinoic acid syndrome
Commentary
Blogs on Retinoic acid syndrome
Definitions
Definitions of Retinoic acid syndrome
Patient Resources / Community
Patient resources on Retinoic acid syndrome Discussion groups on Retinoic acid syndrome Patient Handouts on Retinoic acid syndrome Directions to Hospitals Treating Retinoic acid syndrome Risk calculators and risk factors for Retinoic acid syndrome
Healthcare Provider Resources
Symptoms of Retinoic acid syndrome Causes & Risk Factors for Retinoic acid syndrome Diagnostic studies for Retinoic acid syndrome Treatment of Retinoic acid syndrome
Continuing Medical Education (CME)
CME Programs on Retinoic acid syndrome
International
Retinoic acid syndrome en Espanol Retinoic acid syndrome en Francais
Business
Retinoic acid syndrome in the Marketplace Patents on Retinoic acid syndrome
Experimental / Informatics
List of terms related to Retinoic acid syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: APML differentiation syndrome; APL differentiation syndrome

Overview

Retinoic acid syndrome (RAS) is a potentially life-threatening complication observed in patients with acute promyelocytic leukemia (APML) and first thought to be specifically associated with all-trans retinoic acid (ATRA) (also known as tretinoin) treatment. Subsequently it was recognized that so-called RAS appeared in APML patients who had been treated with another highly efficacious drug, arsenic trioxide, and yet did not appear in patients treated with tretinoin for other disorders. These facts and others support the notion that RAS depends on the presence of the malignant promyelocytes. This has led to the growing deprecation of the term 'retinoic acid syndrome' and to an increasing use of the term differentiation syndrome to signify this APML treatment complication.

Pathophysiology

Several mechanisms have been speculated including a capillary leak syndrome from cytokine release from the differentiating myeloid cells. Mediation by cathepsin G has also been suggested.

Causes

The etiology of RAS remains unclear. Alternatively, all-trans retinoic acid (ATRA) and arsenic trioxide may cause the maturing myeloid cells to acquire the ability to infiltrate organs such as the lung.

Diagnosis

Symptoms

The syndrome is characterized by dyspnea, fever, weight gain, hypotension, and pulmonary infiltrates.

Laboratory Findings

An elevated white count is sometimes associated with this syndrome, but is not a prerequisite.

Treatment

The treatment of RAS usually involves administering dexamethasone IV, with the dosage usually 10 mg BID for ten days. It is important for patients to discontinue the use of tretinoin due to the elevation of WBC and possible low blood oxygen.

Once RAS has resolved, pro-differentiation chemotherapy can be resumed.