tretinoin and Pseudotumor-Cerebri

Acute promyelocytic leukaemia (APL) in children and adolescents shares many features with APL in adults. There are important distinctions, however, between these age groups in the presentation, complications and treatment outcomes. Paediatric patients are more likely to present with high risk features including elevated WBC count or microgranular variant (M3v). Yet the early death rate is lower in paediatric patients compared to adult patients. Overall outcomes such as CR, OS and EFS appear similar in paediatric and adult patients treated on similar regimens except that very young children may have a higher risk of relapse. While contemporary studies have clearly demonstrated improved survival in adults receiving ATO therapy, currently there is more limited data on the role of ATO in paediatric patients. Here we highlight the similarities and important distinctions between paediatric and adult APL while reviewing available data on treatment of paediatric APL.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Age Factors; Age of Onset; Anthracyclines; Antineoplastic Combined Chemotherapy Protocols; Arsenic Trioxide; Arsenicals; Biomarkers, Tumor; Blood Coagulation Disorders; Bone Marrow Examination; Cell Differentiation; Child; Child, Preschool; Heart Diseases; Humans; Infant; Leukemia, Promyelocytic, Acute; Multicenter Studies as Topic; Neoplasm, Residual; Neoplasms, Second Primary; Oncogene Proteins, Fusion; Oxides; Prognosis; Pseudotumor Cerebri; Randomized Controlled Trials as Topic; Remission Induction; Risk Factors; Salvage Therapy; Tretinoin

Idiopathic intracranial hypertension is a common disorder affecting mainly healthy, young, overweight women. The pathogenesis of this condition is unknown, but it has been shown to follow treatment with several compounds including corticosteroids and vitamin A derivatives. This paper will offer a novel hypothesis and insight on the pathogenesis of drug induced intracranial hypertension following a review and analysis of the literature. Both corticosteroids and vitamin A derivatives have been shown to upregulate the expression of aquaporin 1, a water channel protein. Aquaporin 1 is widely distributed in the human brain and is associated with water secretion into the subarachnoid space. Aquaporin 1 was also shown to participate in the regulation of weight. Agents used for treating idiopathic intracranial hypertension reduce aquaporin 1 expression. Based on these observations, we propose that aquaporin 1 has a pathogenetic role in drug induced idiopathic intracranial hypertension. Over expression of this gene causes increased intracranial pressure, and downregulation reduces pressure and alleviates the symptomatology and complications of idiopathic intracranial hypertension.

Topics: Adrenal Cortex Hormones; Aquaporin 1; Cerebrospinal Fluid; Female; Gene Expression Regulation; Humans; Models, Biological; Pseudotumor Cerebri; Tretinoin

Acute promyelocytic leukemia (APL) is a rare form of acute myeloid leukemia with specific epidemiological, pathogenetic and clinical features. Its frequency varies widely among nations, with a decreased incidence among 'Nordic' origin populations. The molecular hallmark of the disease is the presence of a balanced reciprocal translocation resulting in the PML/RAR-α gene fusion, which represents the target of the all-trans retinoic acid (ATRA) therapy. The introduction of ATRA in conjunction with anthracyclines marked a turning point in the treatment of APL, previously associated with a significant morbidity and mortality. Nowadays the standard front-line therapy for pediatric APL includes ATRA in every phase of the treatment, resulting in a complete remission rate of 90-95%. Here we provide an overview of the role of ATRA in the treatment of pediatric APL, summarizing the most relevant clinical results of recent decades and investigating future therapeutic perspectives for children with APL.

Topics: Anthracyclines; Antibiotics, Antineoplastic; Antineoplastic Agents; Child; Clinical Trials as Topic; Consolidation Chemotherapy; Disease-Free Survival; Humans; Induction Chemotherapy; Leukemia, Promyelocytic, Acute; Maintenance Chemotherapy; Molecular Targeted Therapy; Oncogene Proteins, Fusion; Pseudotumor Cerebri; Remission Induction; Translocation, Genetic; Treatment Outcome; Tretinoin

Topics: Diagnosis, Differential; Humans; Hypervitaminosis A; Isotretinoin; Prognosis; Pseudotumor Cerebri; Retinol-Binding Proteins; Tretinoin; Vitamin A

Pseudotumor cerebri or idiopathic intracranial hypertension is a neurological syndrome characterized by signs and symptoms of intracranial hypertension without clinical and radiological evidence of infective or space occupying lesions. Iatrogenic factors are frequent; in particular, cases of Pseudotumor cerebri associated with all-trans-retinoic acid treatment in acute promyelocytic leukemia (APL) have been frequently described in pediatric patients. We review the literature and give diagnostic and therapeutic guidelines.

Topics: Humans; Leukemia, Promyelocytic, Acute; Pseudotumor Cerebri; Tretinoin

Vitamin A and its metabolites (called retinoids) have been thought to play a role in the development of idiopathic intracranial hypertension (IIH). The IIH Treatment Trial (IIHTT) showed the efficacy of acetazolamide (ACZ) in improving visual field function, papilledema grade, quality of life and cerebrospinal fluid (CSF) pressure. We postulated that IIH patients would demonstrate elevated measures of vitamin A metabolites in the serum and CSF.. Comprehensive measures of serum vitamin A and its metabolites were obtained from 96 IIHTT subjects, randomly assigned to treatment with ACZ or placebo, and 25 controls with similar gender, age and body mass index (BMI). These included retinol, retinol binding protein, all-trans retinoic acid (ATRA), alpha- and beta-carotenes, and beta-cryptoxanthin. The IIHTT subjects also had CSF and serum vitamin A and metabolite measurements obtained at study entry and at six months.. At study entry, of the vitamin A metabolites only serum ATRA was significantly different in IIHTT subjects (median 4.33nM) and controls (median 5.04nM, p=0.02). The BMI of IIHTT subjects showed mild significant negative correlations with serum ATRA, alpha- and beta-carotene, and beta-cryptoxanthin. In contrast, the control subject BMI correlated only with serum ATRA. At six months, the serum retinol, alpha-carotene, beta-carotene, and CSF retinol were increased from baseline in the ACZ treated group, but only increases in alpha-carotene (p=0.02) and CSF ATRA (p=0.04) were significantly greater in the ACZ group compared with the placebo group. No other vitamin A measures were significantly altered over the six months in either treatment group. Weight loss correlated with only with the change in serum beta-carotene (r=-0.44, p=0.006) and the change in CSF retinol (r=-0.61, p=0.02).. Vitamin A toxicity is unlikely a contributory factor in the causation of IIH. Our findings differ from those of prior reports in part because of our use of more accurate quantitative methods and measuring vitamin A metabolites in both serum and CSF. ACZ may alter retinoid metabolism in IIH patients.

Topics: Acetazolamide; Adult; Anticonvulsants; Carotenoids; Chromatography, High Pressure Liquid; Chromatography, Liquid; Female; Follow-Up Studies; Humans; Male; Mass Spectrometry; Obesity; Pseudotumor Cerebri; Retinol-Binding Proteins; Tretinoin; Visual Fields; Vitamin A; Young Adult

Preclinical data have shown that all-trans retinoic acid (ATRA) with interferon-alpha (IFN-alpha) can exert significant suppressive effects on Philadelphia-chromosome (Ph)-positive cells. The aim of this study combining IFN-alpha, low-dose cytosine arabinoside (ara-C) and ATRA was to increase the proportion of patients achieving a major cytogenetic response, in comparison with a group of 140 patients previously treated with IFN-alpha plus low-dose ara-C. Forty three patients with Ph-positive CML in early chronic phase were treated with IFN-alpha 5 MU/m2 s.c. daily, low-dose ara-C 10 mg s.c. daily and ATRA 45 mg/m2 orally daily, for 7 consecutive days every other week. Overall, 76% of patients achieved a complete hematologic response (CHR). A cytogenetic response was in observed 59% (major in 38% and complete in 17%). Compared with patients treated with IFN-alpha and low-dose ara-C, those receiving additional ATRA had a lower CHR rate (p. 014), but other response rates were similar. Severe toxicities were common with the triple regimen (64%), mostly related to ATRA therapy. Two patients experienced pseudotumor cerebri; two patients had leukocytosis during the week on ATRA treatment, decreasing during the week off (one suffered a severe asthma-like reaction followed by pulmonary edema, resembling ATRA syndrome). Six patients had other unusual side-effects: aseptic necrosis of the hip (1 patient), ataxic syndrome (1 patient), paranoid syndrome (2 patients), syncopal episodes (1 patient), pure red cell aplasia (1 patient). In conclusion the results of IFN-alpha and low-dose ara-C combined with ATRA in patients with early CML-chronic phase were disappointing, due to excessive toxicity. Whether different ATRA dose schedules may result in fewer side-effects and improve hematologic and cytogenetic response remains to be determined.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Ataxia; Combined Modality Therapy; Cytarabine; Drug Administration Schedule; Female; Femur Head Necrosis; Humans; Immunologic Factors; Interferon-alpha; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukocytosis; Life Tables; Male; Middle Aged; Paranoid Disorders; Pilot Projects; Pseudotumor Cerebri; Pulmonary Edema; Red-Cell Aplasia, Pure; Remission Induction; Survival Analysis; Syncope; Treatment Outcome; Tretinoin

Recent reports of the dramatic antitumor effect of all-trans-retinoic acid (RA) in patients with acute promyelocytic leukemia (APL) have renewed interest in the oncologic indications for retinoids. Furthermore, a variety of pediatric tumors are responsive to RA in vitro, which provides additional rationale for a phase I evaluation of RA in children with cancer that is refractory to standard therapy.. A phase I trial of RA administered orally twice daily for 28-day treatment courses was performed. Cohorts of at least three pediatric cancer patients were entered at successive RA dose levels (from 45 to 80 mg/m2/d) until dose-limiting toxicity (DLT) was consistently observed.. The maximum-tolerated dose (MTD) of RA was 60 mg/m2/d. Three of eight patients at the 80-mg/m2/d dose level developed reversible pseudotumor cerebri that necessitated discontinuation of the agent. Both patients with APL achieved complete remission (CR), whereas no patients with solid tumors had objective responses. Pharmacokinetic studies demonstrated a relatively short terminal half-life for RA (45 minutes), with diminution in plasma levels after chronic dosing.. The MTD and recommended phase II dose for RA in children is 60 mg/m2/d given twice daily. Reversible CNS toxicity related to RA-induced pseudotumor cerebri is dose-limiting. Two children with APL achieved a CR to RA, which supports the inclusion of pediatric patients in clinical trials that evaluate the use of RA for patients with APL.

Topics: Administration, Oral; Adolescent; Adult; Capsules; Child; Child, Preschool; Cohort Studies; Drug Administration Schedule; Half-Life; Humans; Neoplasms; Pseudotumor Cerebri; Tretinoin

Idiopathic intracranial hypertension (IIH) (pseudotumor cerebri) is a rare side effect of all-trans retinoic acid (ATRA). IIH cases have been observed after the concomitant use of ATRA with azole group antimicrobials such as fluconazole and voriconazole. Here, we discuss about the diagnosis and treatment process of the IIH emerging in a young acute promyelocytic leukemia (APL) case with the ATRA impact, which can be increased by posaconazole.. ATRA treatment and posaconazole were interrupted. Systemic acetazolamide and dexamethasone treatment were initiated. After significant clinical response was observed, ATRA treatment was resumed without posaconazole and a similar clinical condition did not recur.. The combined use of ATRA and azole group drugs increases the risk of developing IIH. Patients with APL who developed IIH during the concomitant use of ATRA and fluconazole or voriconazole have been reported. To the best of our knowledge, our case is the first APL case with a IIH who treated with ATRA-based therapy and used posaconazole. In case of development of side effects, drugs should be interrupted and this combination should be avoided if possible after appropriate approach and clinical improvement.

Topics: Adult; Fluconazole; Humans; Leukemia, Promyelocytic, Acute; Male; Papilledema; Pseudotumor Cerebri; Tretinoin; Triazoles; Voriconazole; Young Adult

Treatment of acute promyelocytic leukaemia has emerged as a major success in hemato-oncology. While literature from the developed world boasts of outstanding outcomes, there is a paucity of data from the developing world. This study aimed to assess complications and outcomes of acute promyelocytic leukaemia in a resource-constrained setting.. We retrospectively collected data from patients diagnosed with APL from January 2016 to December 2020.. Sixty-four patients were treated-32 in both the Sanz high and low-risk groups. In the Sanz low-risk group, 12.5% of patients received ATRA with daunorubicin and 81.25% received ATRA with ATO. In the Sanz high-risk group, 18.8% of patients received ATRA with daunorubicin, 34.3% received ATRA with daunorubicin and ATO while 40.6% received ATRA with ATO. 56.25% of patients developed differentiation syndrome. The incidence was higher in Sanz high-risk group as compared to Sanz low-risk group. 57.4% of patients had an infection at the time of presentation. 62.5% of patients developed neutropenic fever during treatment. 17.2% of patients developed pseudotumor cerebri. The 4-year EFS and OS were 71.25 and 73.13%, respectively. Sanz low-risk group had a better 4-year EFS and OS as compared to the Sanz high-risk group. Haemoglobin at presentation and Sanz high-risk group were associated with poorer outcomes with a hazard ratio of 0.8 and 3.1, respectively. Outcomes in high-risk patients were better with the use of ATRA + ATO + daunorubicin.. In the Indian population, APL patients have a high incidence of differentiation syndrome, pseudotumor cerebri, and infections during induction. CR, EFS, and OS compared to the developed world can be achieved with optimal therapy. Low haemoglobin at presentation and Sanz high-risk group were associated with poorer outcomes. ATRA, ATO, and daunorubicin combination is the preferred protocol for treating high-risk patients.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cohort Studies; Daunorubicin; Humans; Leukemia, Promyelocytic, Acute; Pseudotumor Cerebri; Retrospective Studies; Syndrome; Treatment Outcome; Tretinoin

Pseudotumor cerebri (PTC), also known as idiopathic or benign intracranial hypertension, is characterized by elevated intracranial pressure without any evidence of organic central nervous system disorders. PTC is a rare but well-known adverse event associated with all-trans retinoic acid (ATRA) treatment. Persistent blindness in about 10% of affected patients is caused by PTC; therefore, prompt and accurate diagnosis is required. Recently, magnetic resonance imaging (MRI) findings, including empty sella, flattening of the posterior aspect of the globe, and distention of the perioptic subarachnoid space, have been found to be of high diagnostic value in PTC, but there apparently have been no reports about MRI findings in ATRA-induced PTC. We report here an 11-year-old boy with acute promyelocytic leukemia who developed ATRA-induced PTC during leukemia treatment. MRI findings beneficial for the diagnosis of PTC were observed.

Topics: Antineoplastic Agents; Child; Humans; Leukemia, Promyelocytic, Acute; Magnetic Resonance Imaging; Male; Prognosis; Pseudotumor Cerebri; Tretinoin

Multiple randomized trials have demonstrated a benefit for all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APL). Pseudotumor cerebri (PTC) is an infrequently reported adverse effect of ATRA.. We examined the incidence, clinical course, and outcomes of patients with APL treated on Intergroup Protocol 0129 (I0129) who developed PTC. This trial evaluated the role of ATRA alone during induction and/or as maintenance therapy.. Of the patients on trial, 240 received ATRA during induction, maintenance, or both; 8 had a clinical suspicion for PTC. Upon review of individual cases, this was felt to be "probable" in 4 patients, "possible" in 1 and "unlikely" in 3 due to lack of diagnostic criteria or presence of a more likely alternate diagnosis.. "Probable" PTC occurred in 1.7% of patients who received ATRA during induction and/or maintenance therapy. In agreement with previous reports, the incidence of PTC in APL patients receiving ATRA was higher in the pediatric population. Here, we discuss the method for diagnosing PTC in the setting of ATRA therapy and management strategies.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Child; Child, Preschool; Female; Humans; Incidence; Induction Chemotherapy; Leukemia, Promyelocytic, Acute; Maintenance Chemotherapy; Male; Pseudotumor Cerebri; Randomized Controlled Trials as Topic; Treatment Outcome; Tretinoin; Young Adult

Acute promyelocytic leukemia (APML) is considered to be sensitive to all-trans-retinoic acid (ATRA) which acts as a differentiating agent. ATRA is considered to be a well-tolerated agent and is known to achieve complete remission in acute promyelocytic leukemia. However, a few cases on long term all-trans-retinoic acid (ATRA) use can develop pseudotumor cerebri. Out of 32 patients with APML who were treated in our Centre over a 4-year-period, we encountered 6 patients who developed ATRA-related pseudotumor cerebri while on maintenance treatment. The patients ranged from 12 to 40 years of age. 3 patients complained of unbearable headache, 2 of diplopia and 1 of gross reduction in visual acuity. CT scans and MRI did not reveal any intracranial lesions. Cerebrospinal fluid (CSF) examination was normal with CSF manometry revealing a high CSF pressure (average of 345mmH2O). Fundoscopy revealed papilledema in 5 patients and optic atrophy in 1 patient. The patients were successfully managed with decrease dose/discontinuation of ATRA, use of acetazolamide, corticosteroids and therapeutic CSF drainage.

Topics: Adolescent; Adult; Antineoplastic Agents; Child; Female; Humans; Leukemia, Promyelocytic, Acute; Male; Pseudotumor Cerebri; Tertiary Care Centers; Tretinoin; Young Adult

Topics: Adult; Antineoplastic Agents; Female; Humans; Leukemia, Promyelocytic, Acute; Pseudotumor Cerebri; Remission Induction; Time Factors; Tretinoin

Tetracyclines are a commonly prescribed medication for the treatment of acne vulgaris that are associated with pseudotumor cerebri (PTC). With doxycycline specifically, however, the incidence of PTC is very rare. A patient was using oral doxycycline and topical retinoids for acne, and within two months she developed PTC. This case illustrates that despite the rarity of doxycycline-induced PTC, patients and physicians should be aware of this possibility. Furthermore, in the setting of new-onset headaches or visual changes, early ophthalmologic examination for papilledema is recommended for early diagnosis.

Topics: Acne Vulgaris; Administration, Topical; Anti-Bacterial Agents; Doxycycline; Female; Humans; Keratolytic Agents; Pseudotumor Cerebri; Tretinoin; Young Adult

Topics: Antineoplastic Agents; Child; Humans; Male; Pseudotumor Cerebri; Tretinoin

Topics: Acetazolamide; Adult; Anticonvulsants; Antineoplastic Agents; Female; Humans; Idarubicin; Leukemia, Promyelocytic, Acute; Obesity; Pseudotumor Cerebri; Spinal Puncture; Tretinoin

The diagnosis of pseudotumor cerebri (PC) is based on the triad of: (1) papilledema, (2) elevated intracranial pressure with a normal cerebrospinal constituency and (3) normal central nervous system imaging studies. It is an uncommon complication of all-trans-retinoic acid (ATRA) therapy in children treated for acute promyelocytic leukaemia (APL). Its occurrence is rare among adult patients with APL and treated with ATRA . We report a case of an adult with APL who developed PC during induction therapy with ATRA-PC was managed with repeated lumbar punctures and corticotherapy.

Topics: Adult; Antineoplastic Agents; Female; Humans; Pseudotumor Cerebri; Tretinoin

Topics: Adult; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Humans; Intracranial Pressure; Leukemia, Promyelocytic, Acute; Male; Papilledema; Pseudotumor Cerebri; Retinal Hemorrhage; Tretinoin

Topics: Adolescent; Cerebrospinal Fluid; Chronology as Topic; Female; Humans; Leukemia, Promyelocytic, Acute; Pseudotumor Cerebri; Tretinoin

Thymic hyperplasia can occur after cytotoxic therapy for various malignancies. The possible cause could be rebound enlargement after initial atrophy caused by these drugs. During the treatment of hematological malignancies this could be a cause of great concern. We report here a case of thymic hyperplasia after chemotherapy for acute myeloid leukemia. Awareness of this unusual side-effect may prevent needless investigation and therapy.

Topics: Antineoplastic Combined Chemotherapy Protocols; Child; Cytarabine; Daunorubicin; Female; Humans; Hyperplasia; Leukemia, Promyelocytic, Acute; Pseudotumor Cerebri; Radiography; Sweet Syndrome; Thymus Gland; Tretinoin

Topics: Antineoplastic Agents; Child; Diplopia; Female; Headache; Humans; Leukemia, Promyelocytic, Acute; Paralysis; Pseudotumor Cerebri; Tretinoin; Trochlear Nerve Diseases

Pseudotumor cerebri is a condition characterized by increased intracranial pressure with normal cerebrospinal fluid composition. It is usually associated with many medical conditions and drugs. It has been reported that all-trans-retinoic acid can induce pseudotumor cerebri. The authors report a 35-year-old patient diagnosed with acute promyelocytic leukemia who developed pseudotumor cerebri after receiving all-trans-retinoic acid. The patient was treated with 60 mg/day of all-trans-retinoic acid. Two weeks later, she had severe headache and blurred vision. The neurological examination revealed papilledema and decreased visual acuity. Other physical examinations were unremarkable. Brain CT was normal. Additionally, lumbar puncture was performed and the CSF finding was normal except for high CSF pressure. According to modified Dandy criteria, the diagnosis was pseudotumor cerebri. The patient's symptoms disappeared after all-trans-retinoic acid was discontinued. To our knowledge, this is the first case report in Thailand.

Topics: Adult; Antineoplastic Agents; Female; Humans; Leukemia, Promyelocytic, Acute; Pseudotumor Cerebri; Tretinoin

Topics: Adult; Female; Humans; Leukemia, Promyelocytic, Acute; Pseudotumor Cerebri; Remission Induction; Tretinoin

A 17-year-old girl with acute pomyelocytic leukemia (APL) went into complete remission following Daunorubicin, Ara-C and ATRA chemotherapy for 1 month. Unfortunately, prolonged administration of ATRA 6 weeks later caused binocular diplopia with left abducent nerve paresis, which gradually disappeared upon withdrawal of ATRA. We propose that it is ATRA induced pseudotumour cerebri and present this case to discuss the relationship between the ATRA and pseudotumour cerebri.

Topics: Adolescent; Antineoplastic Agents; Female; Humans; Leukemia, Promyelocytic, Acute; Pseudotumor Cerebri; Tretinoin

We report a rare case of pseudotumor cerebri associated with all-trans retinoic acid (ATRA) treatment of acute promyelocytic leukemia (APL). An 18-year-old male was admitted to our hospital complaining of palpitations and shortness of breath; he was found to have APL. The administration of ATRA and chemotherapy was started. After 23 days, he complained of nausea, headache and double vision. Computed tomography and magnetic resonance imaging of the head showed no intracranial abnormalities. Bilateral papilledema, a symptom of increased intracranial pressure, was noted. A diagnosis of pseudotumor cerebri was made. Symptoms were improved by administration of glycerin and the discontinuation of ATRA. After 29 days, a complete remission was achieved.

Topics: Adolescent; Antineoplastic Agents; Gene Rearrangement; Glycerol; Humans; Leukemia, Promyelocytic, Acute; Male; Pseudotumor Cerebri; Receptors, Retinoic Acid; Retinoic Acid Receptor alpha; Tretinoin

A 21-year-old Japanese woman was referred to our hospital because of severe anemia and thrombocytopenia. Bone marrow aspiration showed a hypercellular marrow with 91.5% promyelocytes. Cytochemical study and surface marker a diagnosis of acute promyelocytic leukemia. Because leukocyte count elevated, she was treated with all-trans retinoic acid (ATRA) after conventional chemotherapy. After 11 days of ATRA therapy, the patient started to develop severe headache, nausea and diplopia. Ophthalmologic examination revealed bilateral papilledema. Computed tomography and magnetic resonance imaging of the head showed no intracranial lesion. ATRA was discontinued because it was suspected to cause intracranial hypertension. Her symptoms were relieved and patilledema improved gradually. ATRA is safe and well-tolerated, if the retinoic acid syndrome can be prevented or managed. As the tolerable dose of ATRA in adults is higher than that in children, the side effects tend to occur in children. In Japan, only two childhood cases of intracranial hypertension during ATRA therapy have been reported. We must remember the possibility of intracranial hypertension during ATRA therapy, even in adults.

Topics: Adult; Antineoplastic Agents; Female; Humans; Leukemia, Promyelocytic, Acute; Pseudotumor Cerebri; Tretinoin

Topics: Adolescent; Antineoplastic Agents; Humans; Leukemia, Promyelocytic, Acute; Male; Pseudotumor Cerebri; Remission Induction; Tretinoin

A 30-year-old woman with acute promyelocytic leukaemia (APL) went into complete remission following idarubicin and cytarabine chemotherapy; 18 months later she developed repeated skin relapse, with no bone marrow involvement. DNA and RNA analysis of skin lesions revealed the presence of the PML/RAR alpha hybrid gene, which was not detected at the same time in bone marrow. The skin relapses were successfully treated by all-trans-retinoic acid (ATRA) as single agent over 2 years. However, prolonged administration of ATRA caused pseudotumour cerebri, which disappeared upon drug withdrawal. The absence of the hybrid gene in the bone marrow by RT-PCR analysis led to the patient being autografted.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Base Sequence; Blotting, Southern; Cytarabine; Female; Humans; Idarubicin; Leukemia, Promyelocytic, Acute; Molecular Sequence Data; Polymerase Chain Reaction; Pseudotumor Cerebri; Skin Neoplasms; Tretinoin

Topics: Adolescent; Antineoplastic Agents; Bone Marrow Transplantation; Female; Humans; Leukemia, Promyelocytic, Acute; Pseudotumor Cerebri; Recurrence; Tretinoin; Whole-Body Irradiation

Topics: Adult; Child, Preschool; Drug Tolerance; Dyspnea; Humans; Leukemia, Promyelocytic, Acute; Leukocytosis; Pseudotumor Cerebri; Tretinoin

Topics: Aged; Dyspnea; Female; Humans; Leukemia, Promyelocytic, Acute; Leukocytosis; Male; Middle Aged; Pseudotumor Cerebri; Tretinoin

Tretinoin is effective in acute promyelocytic leukaemia in adults. Data about its efficacy and safety in children are limited. We have treated 9 children with tretinoin at 45 mg/m2 per day. Pseudotumour cerebri or hyperleucocytosis occurred in 5 patients. Retinoic acid syndrome was seen in 3 cases. 1 of 2 children who developed hyperleucocytosis, pseudotumour cerebri, and retinoic acid syndrome died despite steroids and mechanical ventilation. Complete remissions with tretinoin alone were achieved in 15 patients. All 8 surviving children received consolidation chemotherapy. Our experience with tretinoin therapy suggests that toxicity is frequent in children.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Leukemia, Promyelocytic, Acute; Leukocyte Count; Leukocytes; Male; Pseudotumor Cerebri; Syndrome; Tretinoin

A case of pseudo-tumor cerebri is reported in a woman being treated with minocycline and tretinoin for acne who also ingested liver as a self-treatment for her condition. A possible cumulative effect between these agents is postulated.

Topics: Acne Vulgaris; Adult; Female; Humans; Minocycline; Pseudotumor Cerebri; Tretinoin

Pseudotumor cerebri developed in a 14-year-old girl with nodulocystic acne, who was taking excessive amounts of a synthetic vitamin A derivative. Although hypervitaminosis A has reportedly caused pseudotumor, Accutane has not previously been implicated.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Isotretinoin; Pseudotumor Cerebri; Tretinoin; Vitamin A

Topics: Abnormalities, Drug-Induced; Corneal Opacity; Humans; Ileitis; Isotretinoin; Pseudotumor Cerebri; Tretinoin; Uric Acid