Document Detail

Retinoic acid syndrome: a review.
MedLine Citation:
PMID:  18613850     Owner:  NLM     Status:  MEDLINE    
The retinoic acid syndrome (RAS) is an unpredictable but frequent complication which may develop after administration of all-trans retinoic acid (ATRA) most commonly in patients with acute promyelocytic leukaemia (APL). In this review, we describe the incidence, predictive factors, clinical course, outcome and treatment of RAS in patients with APL treated with ATRA. The incidence of RAS in patients receiving ATRA is about 14-16%, with an associated mortality of about 2%. Initial high white blood cell (WBC) count, rapidly increasing WBC count and/or the presence of the CD 13 expression on leukaemic cells may help in identifying patients likely to develop RAS. Concurrent chemotherapy will probably decrease the risk of developing RAS but often exacerbates bleeding, leading to leucocytosis, thrombocytopenia, disseminated intravascular coagulation and fibrinolysis. Prophylactic steroids are not recommended but prompt administration of steroids at the first sign of unexplained dyspnea, fever, weight gain or pulmonary infiltrate, is critical. Liposomal ATRA is being investigated to induce haematological cure in APL without chemotherapy and to reduce the incidence of RAS but further validation of its usefulness is necessary.
E Patatanian; D F Thompson
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of clinical pharmacy and therapeutics     Volume:  33     ISSN:  1365-2710     ISO Abbreviation:  J Clin Pharm Ther     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-10     Completed Date:  2008-08-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8704308     Medline TA:  J Clin Pharm Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  331-8     Citation Subset:  IM    
Department of Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK 73103, USA.
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MeSH Terms
Antigens, CD13
Antineoplastic Agents / administration & dosage,  adverse effects*,  therapeutic use
Antineoplastic Combined Chemotherapy Protocols / adverse effects,  therapeutic use
Gene Expression Regulation, Neoplastic
Glucocorticoids / therapeutic use
Leukemia, Promyelocytic, Acute / drug therapy*
Leukocyte Count
Tretinoin / administration & dosage,  adverse effects*,  therapeutic use
Reg. No./Substance:
0/Antineoplastic Agents; 0/Glucocorticoids; 302-79-4/Tretinoin; EC, CD13

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