tretinoin and Thromboembolism

The antitumor effect of different retinoids focused attention in the treatment of malignant disorders on different pathways. The therapeutic effect was proved in acute promyelocytic leukaemia, but was limited in juvenile form of chronic myeloid leukaemia and in acute myelomonocytic and monoblastic leukaemia. Combined with different leukostatics, long remission could be achieved. The most important therapeutic pathway is direct growth inhibition with and without cell differentiation. Clinically, retinoids are effective in tumours, like: cutan T-cell lymphoma, mycosis fungoides, Sézary syndrome, oral leukoplakia (prevention of head and neck cancer metastases), variant form of small lung cell carcinoma, oestrogen dependent breast-carcinoma and cervix-carcinoma. The most serious complication of the retinoids' administration is the retinoic acid syndrome which is followed sometimes with thromboembolic events. Retinoids are teratogenic and hepatotoxic.

Topics: Blood Coagulation Disorders; Hematologic Diseases; Hematopoietic System; Humans; Leukemia; Neoplasms; Retinoids; Thromboembolism; Tretinoin

Ten patients with acute promyelocytic leukemia (APL) were treated with all-trans retinoic acid (ATRA). Eight of 10 patients achieved complete remission (CR), and among the 8 newly diagnosed cases, 7 achieved CR. Five of 8 CR cases remained in CR after 8 to 30 months. Except for hypotension and a large gastric ulcer resulting from hyperhistaminemia, the adverse effects of ATRA were generally mild. Severe thrombotic tendency occurred in a patient treated with ATRA combined with tranexamic acid. Intensive chemotherapy consisting of daunorubicin (DNR) and other agents was scheduled for the patients who achieved CR with ATRA.

Topics: Adult; Aged; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Disease-Free Survival; Female; Humans; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Remission Induction; Thromboembolism; Treatment Outcome; Tretinoin

A case of acute promyelocytic leukemia (APL) treated with all-trans retinoic acid (ATRA) is reported. After the diagnosis was established, the patient was given oral ATRA (30 mg/d) in combination with small dose of hydroxyurea, platelet concentrates, and fresh frozen plasma etc. From day 19 after ATRA administration, successive thromboembolic events occurred. In spite of the partial remission on day 32, the patient died of cardiopulmonary insufficiency. Our experience from this case suggests that more attention should be given to thromboembolic events during ATRA therapy, and the use of active anti-coagulant may prove beneficial when signs of hypercoagulation are present in APL patients.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Fatal Outcome; Humans; Hydroxyurea; Leukemia, Promyelocytic, Acute; Male; Thromboembolism; Tretinoin

All-trans-retinoic acid (ATRA) can induce a clinical remission in patients with acute promyelocytic leukemia. An adverse condition called "retinoic acid syndrome" limits this therapy. It is characterized by fever and respiratory distress, along with weight gain, pleural or pericardial effusions, peripheral edema, thromboembolic events, and intermittent hypotension. The lung disease has been previously ascribed to an infiltration of leukemic or maturing myeloid cells into lung parenchyma, which is sometimes associated with pleural effusions and diffuse alveolar hemorrhage. We report a case of retinoic acid syndrome in an 18-yr-old woman who developed diffuse alveolar hemorrhage while being treated with ATRA for acute promyelocytic leukemia. An open lung biopsy revealed pulmonary capillaritis.

Topics: Adolescent; Antineoplastic Agents; Capillaries; Edema; Female; Fever; Hemoptysis; Humans; Hypotension; Leukemia, Promyelocytic, Acute; Lung; Pericardial Effusion; Pleural Effusion; Pulmonary Alveoli; Respiratory Insufficiency; Syndrome; Thromboembolism; Tretinoin; Vasculitis; Weight Gain

We describe a case of acute promyelocytic leukaemia where the combined use of all-trans retinoic acid and an antifibrinolytic (aprotinin) may have contributed to worsening of coagulopathy.

Topics: Adult; Antineoplastic Agents; Aprotinin; Fatal Outcome; Female; Hemostatics; Humans; Leukemia, Promyelocytic, Acute; Thromboembolism; Tretinoin

In contrast to patients with disseminated intravascular coagulation (DIC) due to other causes, patients with acute promyelocytic leukemia (APL) receiving standard cytotoxic chemotherapy can be treated safely with antifibrinolytic drugs for prophylaxis of hemorrhage, without the occurrence of thromboembolic complications. However, such drugs should be used cautiously in APL patients who are receiving all-trans retinoic acid (ATRA) differentiation therapy. We report here a patient with APL who had fatal thromboembolism after receiving ATRA and tranexamic acid therapy.

Topics: Acute Kidney Injury; Antifibrinolytic Agents; Drug Interactions; Fatal Outcome; Female; Hemorrhage; Humans; Leukemia, Promyelocytic, Acute; Middle Aged; Thromboembolism; Tretinoin

The clinical course of three patients with acute promyelocytic leukemia receiving all-trans retinoic acid (ATRA) as a single agent is reported. The first two patients were in first and second relapse of their leukemia that had occurred despite maintenance treatment with 13-cis retinoic acid after chemotherapy-induced complete remission (CR). A switch to ATRA was followed by achievement of a CR in two patients. The third patient received ATRA as first-line therapy. Two patients experienced thromboembolic complications during the phase of ATRA-induced leukocytosis. One of them died of pulmonary embolism on day 16 of treatment. The two responding patients who did not receive consolidation chemotherapy relapsed after 6 and 9 months, respectively. Increase of the ATRA dose failed to induce a new remission.

Topics: Adult; Aged; Female; Humans; Leukemia, Promyelocytic, Acute; Male; Neoplasm Recurrence, Local; Remission Induction; Stereoisomerism; Thromboembolism; Tretinoin

Topics: Adult; Humans; Leukemia, Promyelocytic, Acute; Male; Thromboembolism; Tretinoin