Acute promyelocytic leukemia medical therapy: Difference between revisions
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===Anti-leukemic Therapies=== | ===Anti-leukemic Therapies=== | ||
*'''All-''trans'' retinoic acid''': | *'''All-''trans'' retinoic acid''': The introduction of all-''trans'' retinoic acid has revolutionized the treatment paradigm and outcomes in acute promyelocytic leukemia. | ||
**''Adverse effects'': The most unique adverse effect of all-''trans'' retinoic acid is differentiation syndrome. This is characterized by weight gain, edema, hypoxia, dyspnea, and pulmonary infiltrates. | |||
*'''Arsenic trioxide''': | *'''Arsenic trioxide''': | ||
**''Adverse effects: The adverse effects of arsenic trioxide include myelosuppression, liver dysfunction, QT interval prolongation, liver dysfunction.<ref name="pmid28352191">{{cite journal| author=McCulloch D, Brown C, Iland H| title=Retinoic acid and arsenic trioxide in the treatment of acute promyelocytic leukemia: current perspectives. | journal=Onco Targets Ther | year= 2017 | volume= 10 | issue= | pages= 1585-1601 | pmid=28352191 | doi=10.2147/OTT.S100513 | pmc=5359123 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28352191 }} </ref> | **''Adverse effects'': The adverse effects of arsenic trioxide include myelosuppression, liver dysfunction, QT interval prolongation, liver dysfunction.<ref name="pmid28352191">{{cite journal| author=McCulloch D, Brown C, Iland H| title=Retinoic acid and arsenic trioxide in the treatment of acute promyelocytic leukemia: current perspectives. | journal=Onco Targets Ther | year= 2017 | volume= 10 | issue= | pages= 1585-1601 | pmid=28352191 | doi=10.2147/OTT.S100513 | pmc=5359123 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28352191 }} </ref> | ||
===Supportive Therapies=== | ===Supportive Therapies=== | ||
Revision as of 02:41, 7 May 2018
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Acute promyelocytic leukemia Microchapters |
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Differentiating Acute promyelocytic leukemia from other Diseases |
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Risk calculators and risk factors for Acute promyelocytic leukemia medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
APL is unique among the leukemias distinguished by its sensitivity to all-trans retinoic acid (ATRA), a derivative of vitamin A. Treatment with ATRA causes differentiation of the immature leukemic promyelocytes into mature granulocytes. ATRA is typically combined with anthracycline based chemotherapy resulting in a clinical remission in approximately 90% of patients.
ATRA therapy is associated with the unique side effect of retinoic acid syndrome. This is associated with the development of dyspnea, fever, weight gain, peripheral edema and is treated with dexamethasone. The etiology of retinoic acid syndrome has been attributed to capillary leak syndrome from cytokine release from the differentiating promyelocytes.
Treatment options for patients with relapsed disease include arsenic trioxide and allogeneic stem cell transplant. Monitoring for relapse using PCR tests for RARα allows early re-treatment which is successful in many instances.
Anti-leukemic Therapies
- All-trans retinoic acid: The introduction of all-trans retinoic acid has revolutionized the treatment paradigm and outcomes in acute promyelocytic leukemia.
- Adverse effects: The most unique adverse effect of all-trans retinoic acid is differentiation syndrome. This is characterized by weight gain, edema, hypoxia, dyspnea, and pulmonary infiltrates.
- Arsenic trioxide:
- Adverse effects: The adverse effects of arsenic trioxide include myelosuppression, liver dysfunction, QT interval prolongation, liver dysfunction.[1]
Supportive Therapies
References
- ↑ McCulloch D, Brown C, Iland H (2017). "Retinoic acid and arsenic trioxide in the treatment of acute promyelocytic leukemia: current perspectives". Onco Targets Ther. 10: 1585–1601. doi:10.2147/OTT.S100513. PMC 5359123. PMID 28352191.