differentiation syndrome aka retinoic acid syndrome
- related: Oncology
- tags: #literature #boards
This patient has developed differentiation syndrome (formerly called retinoic acid syndrome). The syndrome can include fever, peripheral edema with weight gain, pulmonary infiltrates, hypoxemia, respiratory distress, hypotension, renal and hepatic dysfunction, rash, and pleural and pericardial effusions. The syndrome occurs in approximately 25% of patients with acute promyelocytic leukemia during induction therapy that includes the differentiation agents all-trans retinoic acid (tretinoin) or arsenic trioxide (choice A is correct) and is believed to result from a release of inflammatory cytokines from malignant promyelocytes. No specific risk factors permit identification of patients with acute promyelocytic leukemia who are likely to develop differentiation syndrome. Arsenic trioxide also is associated with QT prolongation, although the patient in this scenario did not develop this complication.
Most antineoplastic medications have multiple adverse effects but are not associated with differentiation syndrome. Cytarabine causes bone marrow suppression and may cause cerebellar ataxia in high doses (choice B is incorrect). Daunorubicin and other anthracyclines are best known for their potential cardiotoxicity and promotion of secondary hematologic malignancies (choice C is incorrect). Etoposide is associated with bone marrow suppression, nausea and vomiting, and also can promote secondary malignancies (choice D is incorrect).