Retinoic acid syndrome - Revision history

ClaireLewis at 17:56, 1 October 2019

2019-10-01T17:56:24Z

← Older revision		Revision as of 17:56, 1 October 2019
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	==Background==		==Background==
	*Differentiation syndrome (DS) is most current term		*Differentiation syndrome (DS) is most current term
	*~~APML~~ patients undergoing ATRA treatment (Tretinoin, Vesanoid)		*Occurs in [[AML\|Acute promyelocytic leukemia]] patients undergoing ATRA treatment (Tretinoin, Vesanoid)
	**And/or with arsenic trioxide therapy (Trisenox, ATO)		**And/or with arsenic trioxide therapy (Trisenox, ATO)
	**Chemo treatment differentiates APML blasts into mature granulocytes		**Chemo treatment differentiates APML blasts into mature granulocytes
	**Differentiation of blasts may cause "cytokine storm" leading to tissue damage		**Differentiation of blasts may cause [[sepsis]]-like "cytokine storm" leading to tissue damage
	*Incidence of DS<ref>Montesinos P and Sanz MA. The Differentiation Syndrome in Patients with Acute Promyelocytic Leukemia: Experience of the Pethema Group and Review of the Literature. Mediterr J Hematol Infect Dis. 2011; 3(1): e2011059.</ref>		*Incidence of DS<ref>Montesinos P and Sanz MA. The Differentiation Syndrome in Patients with Acute Promyelocytic Leukemia: Experience of the Pethema Group and Review of the Literature. Mediterr J Hematol Infect Dis. 2011; 3(1): e2011059.</ref>
	**Up to 25% of patients undergoing ATRA		**Up to 25% of patients undergoing ATRA
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	*Diagnosis made clinically with symptomology		*Diagnosis made clinically with symptomology
	**Requires immediate treatment with steroids		**Requires immediate treatment with steroids
	**Steroids highly recommended even if other ~~ddx~~ possible		**Steroids highly recommended even if other diagnoses possible

	==Clinical Features==		==Clinical Features==
	*Unexplained fever		*Unexplained [[fever]]
	*Unexplained hypotension		*Unexplained [[hypotension]]
	*Weight gain > 5 kg		*Weight gain > 5 kg
	*Dyspnea with pulmonary infiltrates		*[[Dyspnea]] with pulmonary infiltrates
	*[[Pericardial effusion]]		*[[Pericardial effusion]]
	*Pleural effusion		*[[Pleural effusion]]
	*Renal failure		*[[Renal failure]]
	*Vascular capillary leak syndrome		*Vascular capillary leak syndrome
	*[[DIC]]		*[[DIC]]
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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Sepsis]]		*[[Sepsis]]
	*Fungal infection		*[[Fungal infection]]
	*Pulmonary hemorrhage		*[[diffuse alveolar hemorrhage\|Pulmonary hemorrhage]]
	*[[Pneumonia]]		*[[Pneumonia]]
	*Renal failure		*[[Renal failure]]
	*[[CHF]]		*[[CHF]]
	*[[Pulmonary embolism]]		*[[Pulmonary embolism]]
	*[[DIC]]		*[[DIC]]

			{{Template:Oncologic emergencies DDX}}

	==Evaluation==		==Evaluation==
			*Ultimately, a clinical diagnosis
	*[[Troponins]] for [[pericarditis]]		*[[Troponins]] for [[pericarditis]]
	*Severe leukocytosis on CBC		*Severe [[leukocytosis]] on CBC
	*[[Sepsis]] workup		*[[Sepsis]] workup
	*[[CHF]] workup, echo		*[[CHF]] workup, echo
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	*Temporary discharge ATRA or ATO only in severe cases of DS (renal failure or ICU admit)		*Temporary discharge ATRA or ATO only in severe cases of DS (renal failure or ICU admit)
	*Supportive		*Supportive
	**Mechanical ventilation for respiratory failure		**[[Mechanical ventilation]] for respiratory failure
	**Careful IVF admin, prioritizing blood products for coagulopathies (DIC)		**Careful [[IVF]] admin, prioritizing [[blood products]] for coagulopathies (DIC)
	**[[Furosemide]] for fluid overload		**[[Furosemide]] for fluid overload
	**CRRT/HD for refractory renal failure		**CRRT/[[hemodialysis\|HD]] for refractory renal failure
	**[[Vasopressors]]		**[[Vasopressors]]
	**Empiric [[antibiotics]]		**Empiric [[antibiotics]]
	**Avoid invasive pleural/pericardial effusion diagnostics		**''Avoid'' invasive pleural/pericardial effusion diagnostics

	==Disposition==		==Disposition==
			*Admit

	==See Also==		==See Also==

ClaireLewis: /* Evaluation */

2016-09-29T02:47:23Z

Evaluation

← Older revision		Revision as of 02:47, 29 September 2016
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	*[[DIC]] workup		*[[DIC]] workup
	*Coagulation factor levels		*Coagulation factor levels
	*Diagnostic bronchoscopy, BAL, bx usually not required		*Diagnostic bronchoscopy, BAL, biopsy usually not required
	*Imaging		*Imaging
	**[[CXR]] - pleural effusions, ground-glass opacities, increased cardiac silhouette		**[[CXR]] - pleural effusions, ground-glass opacities, increased cardiac silhouette

Rossdonaldson1: Text replacement - "CXR" to "CXR"

2016-09-09T10:15:28Z

Text replacement - "*CXR" to "*CXR"

← Older revision		Revision as of 10:15, 9 September 2016
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	*Diagnostic bronchoscopy, BAL, bx usually not required		*Diagnostic bronchoscopy, BAL, bx usually not required
	*Imaging		*Imaging
	**CXR - pleural effusions, ground-glass opacities, increased cardiac silhouette		**[[CXR]] - pleural effusions, ground-glass opacities, increased cardiac silhouette
	**CT chest - pleural effusions, peripheral nodules		**CT chest - pleural effusions, peripheral nodules

Rossdonaldson1: Text replacement - "Tx" to "treatment"

2016-08-01T13:17:11Z

Text replacement - "Tx" to "treatment"

← Older revision		Revision as of 13:17, 1 August 2016
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	*APML patients undergoing ATRA treatment (Tretinoin, Vesanoid)		*APML patients undergoing ATRA treatment (Tretinoin, Vesanoid)
	**And/or with arsenic trioxide therapy (Trisenox, ATO)		**And/or with arsenic trioxide therapy (Trisenox, ATO)
	**Chemo Tx differentiates APML blasts into mature granulocytes		**Chemo treatment differentiates APML blasts into mature granulocytes
	**Differentiation of blasts may cause "cytokine storm" leading to tissue damage		**Differentiation of blasts may cause "cytokine storm" leading to tissue damage
	*Incidence of DS<ref>Montesinos P and Sanz MA. The Differentiation Syndrome in Patients with Acute Promyelocytic Leukemia: Experience of the Pethema Group and Review of the Literature. Mediterr J Hematol Infect Dis. 2011; 3(1): e2011059.</ref>		*Incidence of DS<ref>Montesinos P and Sanz MA. The Differentiation Syndrome in Patients with Acute Promyelocytic Leukemia: Experience of the Pethema Group and Review of the Literature. Mediterr J Hematol Infect Dis. 2011; 3(1): e2011059.</ref>

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-25T04:55:52Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 04:55, 25 July 2016
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	*[[DIC]]		*[[DIC]]

	==~~Diagnosis~~==		==Evaluation==
	*[[Troponins]] for [[pericarditis]]		*[[Troponins]] for [[pericarditis]]
	*Severe leukocytosis on CBC		*Severe leukocytosis on CBC

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-20T11:12:10Z

Text replacement - "0 mg" to "0mg"

← Older revision		Revision as of 11:12, 20 July 2016
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	==Management<ref>Sanz MA and Montesinos P. How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia. May 1, 2014; Blood: 123 (18).</ref>==		==Management<ref>Sanz MA and Montesinos P. How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia. May 1, 2014; Blood: 123 (18).</ref>==
	*[[Dexamethasone]] ~~10 mg~~ IV q12hrs		*[[Dexamethasone]] 10mg IV q12hrs
	**Most important therapy, with possible dramatic and rapid resolution of symptoms		**Most important therapy, with possible dramatic and rapid resolution of symptoms
	**Continue treatment until complete disappearance of signs and symptoms		**Continue treatment until complete disappearance of signs and symptoms

Neil.m.young: Text replacement - " pt " to " patient "

2016-07-01T23:39:20Z

Text replacement - " pt " to " patient "

← Older revision		Revision as of 23:39, 1 July 2016
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	*Vascular capillary leak syndrome		*Vascular capillary leak syndrome
	*[[DIC]]		*[[DIC]]
	*Never observed beyond induction therapy, when pt has achieved complete response		*Never observed beyond induction therapy, when patient has achieved complete response

	==Differential Diagnosis==		==Differential Diagnosis==

Ostermayer: Text replacement - " d/c" to " discharge"

2016-06-21T16:49:43Z

Text replacement - " d/c" to " discharge"

← Older revision		Revision as of 16:49, 21 June 2016
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	**Most important therapy, with possible dramatic and rapid resolution of symptoms		**Most important therapy, with possible dramatic and rapid resolution of symptoms
	**Continue treatment until complete disappearance of signs and symptoms		**Continue treatment until complete disappearance of signs and symptoms
	*Temporary ~~d/c~~ ATRA or ATO only in severe cases of DS (renal failure or ICU admit)		*Temporary discharge ATRA or ATO only in severe cases of DS (renal failure or ICU admit)
	*Supportive		*Supportive
	**Mechanical ventilation for respiratory failure		**Mechanical ventilation for respiratory failure

Ostermayer: Text replacement - " pts" to " patients"

2016-06-21T16:49:33Z

Text replacement - " pts" to " patients"

← Older revision		Revision as of 16:49, 21 June 2016
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	==Background==		==Background==
	*Differentiation syndrome (DS) is most current term		*Differentiation syndrome (DS) is most current term
	*APML ~~pts~~ undergoing ATRA treatment (Tretinoin, Vesanoid)		*APML patients undergoing ATRA treatment (Tretinoin, Vesanoid)
	**And/or with arsenic trioxide therapy (Trisenox, ATO)		**And/or with arsenic trioxide therapy (Trisenox, ATO)
	**Chemo Tx differentiates APML blasts into mature granulocytes		**Chemo Tx differentiates APML blasts into mature granulocytes
	**Differentiation of blasts may cause "cytokine storm" leading to tissue damage		**Differentiation of blasts may cause "cytokine storm" leading to tissue damage
	*Incidence of DS<ref>Montesinos P and Sanz MA. The Differentiation Syndrome in Patients with Acute Promyelocytic Leukemia: Experience of the Pethema Group and Review of the Literature. Mediterr J Hematol Infect Dis. 2011; 3(1): e2011059.</ref>		*Incidence of DS<ref>Montesinos P and Sanz MA. The Differentiation Syndrome in Patients with Acute Promyelocytic Leukemia: Experience of the Pethema Group and Review of the Literature. Mediterr J Hematol Infect Dis. 2011; 3(1): e2011059.</ref>
	**Up to 25% of ~~pts~~ undergoing ATRA		**Up to 25% of patients undergoing ATRA
	**Up to 31% of ~~pts~~ undergoing ATO		**Up to 31% of patients undergoing ATO
	*Up to 40% mortality in patients requiring mechanical ventilation		*Up to 40% mortality in patients requiring mechanical ventilation
	*Diagnosis made clinically with symptomology		*Diagnosis made clinically with symptomology

Rossdonaldson1 at 00:10, 3 May 2016

2016-05-03T00:10:59Z

← Older revision		Revision as of 00:10, 3 May 2016
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	**Requires immediate treatment with steroids		**Requires immediate treatment with steroids
	**Steroids highly recommended even if other ddx possible		**Steroids highly recommended even if other ddx possible

	~~==Differential==~~
	*[[Sepsis]]
	*Fungal infection
	*Pulmonary hemorrhage
	*[[Pneumonia]]
	*Renal failure
	*[[CHF]]
	*[[Pulmonary embolism]]
	*[[DIC]]

	==Clinical Features==		==Clinical Features==
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	*Never observed beyond induction therapy, when pt has achieved complete response		*Never observed beyond induction therapy, when pt has achieved complete response

	==~~Diagnostics~~==		==Differential Diagnosis==
	*Troponins for pericarditis		*[[Sepsis]]
			*Fungal infection
			*Pulmonary hemorrhage
			*[[Pneumonia]]
			*Renal failure
			*[[CHF]]
			*[[Pulmonary embolism]]
			*[[DIC]]

			==Diagnosis==
			*[[Troponins]] for [[pericarditis]]
	*Severe leukocytosis on CBC		*Severe leukocytosis on CBC
	*[[Sepsis]] workup		*[[Sepsis]] workup
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	==Management<ref>Sanz MA and Montesinos P. How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia. May 1, 2014; Blood: 123 (18).</ref>==		==Management<ref>Sanz MA and Montesinos P. How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia. May 1, 2014; Blood: 123 (18).</ref>==
	*Dexamethasone 10 mg IV q12hrs		*[[Dexamethasone]] 10 mg IV q12hrs
	**Most important therapy, with possible dramatic and rapid resolution of symptoms		**Most important therapy, with possible dramatic and rapid resolution of symptoms
	**Continue treatment until complete disappearance of signs and symptoms		**Continue treatment until complete disappearance of signs and symptoms
Line 56:		Line 56:
	**Mechanical ventilation for respiratory failure		**Mechanical ventilation for respiratory failure
	**Careful IVF admin, prioritizing blood products for coagulopathies (DIC)		**Careful IVF admin, prioritizing blood products for coagulopathies (DIC)
	**Furosemide for fluid overload		**[[Furosemide]] for fluid overload
	**CRRT/HD for refractory renal failure		**CRRT/HD for refractory renal failure
	**Vasopressors		**[[Vasopressors]]
	**Empiric antibiotics		**Empiric [[antibiotics]]
	**Avoid invasive pleural/pericardial effusion diagnostics		**Avoid invasive pleural/pericardial effusion diagnostics

	==~~Sources~~==		==Disposition==
	*Weerakkody Y et al. All trans retinoic acid syndrome. Radiopaedia. http://radiopaedia.org/articles/all-trans-retinoic-acid-syndrome.
			==See Also==

			==External Links==

			==References==
	<references/>		<references/>

	[[Category:Heme/Onc]]		[[Category:Heme/Onc]]