tretinoin and Myocarditis

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Female; Humans; Idarubicin; Leukemia, Promyelocytic, Acute; Male; Mercaptopurine; Methotrexate; Middle Aged; Mitoxantrone; Myocarditis; Tretinoin

Topics: Humans; Myocarditis; Tretinoin

Topics: Adult; Anti-Inflammatory Agents; Antineoplastic Combined Chemotherapy Protocols; Arsenic Trioxide; Cardiovascular Agents; Chest Pain; Drug Substitution; Echocardiography; Electrocardiography; Humans; Idarubicin; Leukemia, Promyelocytic, Acute; Male; Myocarditis; Pericarditis; Remission Induction; Tretinoin

Topics: Angioplasty, Balloon, Coronary; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow; Chromosomes, Human, Pair 15; Chromosomes, Human, Pair 17; Fatal Outcome; Humans; Idarubicin; In Situ Hybridization, Fluorescence; Leukemia, Promyelocytic, Acute; Leukemic Infiltration; Male; Middle Aged; Myeloid Cells; Myocarditis; Myocardium; Translocation, Genetic; Tretinoin

Use of all-transretinoic acid (ATRA) with other chemotherapeutic agents in the treatment of acute promyelocytic leukemia (APL) has been shown to cause the differentiation of abnormally granulated specific blast cells into mature granulocytes by acting on the t(15; 17) fusion gene product. The complete remission rate is increased and survival time is prolonged in APL patients who receive chemotherapy plus ATRA, whereas ATRA syndrome and other ATRA-related adverse effects including pseudo tumor cerebri, headache, severe bone pain, mucosal and skin dryness, hypercholesterolemia, and cheilitis may be observed especially during induction phase of the treatment. In this paper, we report a 9-year-old girl with APL who developed pancarditis while receiving the APL-93 treatment protocol. In our patient, endocarditis and myocarditis were initially determined after ATRA treatment during the induction part of the protocol. All findings disappeared after ATRA was discontinued. When ATRA was readministered in the maintenance part of the treatment protocol, she developed pancarditis and severe pulmonary edema. As her symptoms decreased dramatically with the discontinuation of ATRA and the initiation of steroid treatment, the clinical picture strongly suggested the ATRA treatment as the causative factor. To the best of our knowledge, this clinical picture of pancarditis secondary to ATRA treatment has not been reported earlier in the English literature.

Topics: Antineoplastic Combined Chemotherapy Protocols; Child; Female; Humans; Leukemia, Promyelocytic, Acute; Myocarditis; Pulmonary Edema; Severity of Illness Index; Tretinoin

Topics: Antineoplastic Agents; Humans; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Muscle, Skeletal; Myocarditis; Myositis; Tretinoin