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Differentiation (Retinoic Acid) Syndrome in Critically Ill Cancer Patients

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Oncologic Critical Care

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Abstract

In patients with acute promyelocytic leukemia, induction therapy, primarily with all-trans retinoic acid (ATRA), or arsenic trioxide (ATO), capable of inducing the differentiation of leukemic cells, may lead to the development of a syndrome of differentiation, formerly known as all-trans-retinoic acid syndrome. In this situation, patients who develop the severe form present a high morbimortality rate. The diagnosis requires a high degree of suspicion, and the criteria used are clinical. Originally, the diagnostic criteria were established by Frankel et al. (Ann Intern Med 117(4):292–296, 1992) who were based on seven clinical findings: fever, weight gain (from capillary leak and soft tissue edema, secondary a storm of cytokines), respiratory distress, radiographic opacities, pleural or pericardial effusion, hypotension, and renal failure (usually from hypotension, although disseminated intravascular coagulation may also be present). In this scenario, the use of corticosteroids against suspicion promotes a significant decrease in the mortality rate, changing the prognosis and therefore the course of the disease.

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Authors and Affiliations

  1. Fundação Pio XII – Hospital de Câncer de Barretos, Barretos, São Paulo, Brazil

    Cristina Prata Amendola, Ricardo André Sales Pereira Guedes & Luciana Coelho Sanches

Authors
  1. Cristina Prata Amendola
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  2. Ricardo André Sales Pereira Guedes
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  3. Luciana Coelho Sanches
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Corresponding author

Correspondence to Cristina Prata Amendola .

Editor information

Editors and Affiliations

  1. Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joseph L. Nates

  2. Division of Anesthesiology, Critical Care and Pain Medicine, Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kristen J. Price

Section Editor information

  1. Critical Care Department, Universidad del Rosario Hospital Universitario Fundacion Santa Fe de, Bogota, Colombia, Colombia

    Yenny Cardenas

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Prata Amendola, C., Guedes, R.A.S.P., Sanches, L.C. (2020). Differentiation (Retinoic Acid) Syndrome in Critically Ill Cancer Patients. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74588-6_50

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  • DOI: https://doi.org/10.1007/978-3-319-74588-6_50

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74587-9

  • Online ISBN: 978-3-319-74588-6

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