Saeed Karimi, Morteza Naderan*, Salar Bahrami, Masomeh Sabzevary and Mohammad Naderan
Volume4-Issue11
Dates: Received: 2023-10-30 | Accepted: 2023-11-19 | Published: 2023-11-23
Pages: 1601-1606
Abstract
The ocular manifestations of the differentiation syndrome (DS) are rarely reported in the literature with only six cases published until now. Patients with acute promyelocytic leukemia (APL) who undergo treatment with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) are especially susceptible to developing DS. This is a serious diagnosis with a life-threatening impact on some patients, however, amenable to prophylaxis and treatment by systemic corticosteroids. An exudative retinal detachment (ERD) may either complicate or herald the development of DS. In this article, we present a case of APL who developed ERD in advance of DS symptoms, its multimodal imaging characteristics, and review the published articles concerning this rare disease manifestation.
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DOI: 10.37871/jbres1836
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© 2023 Karimi S, et al. Distributed under Creative Commons CC-BY 4.0
How to cite this article
Karimi S, Naderan M, Bahrami S, Sabzevary M, Naderan M. Exudative Retinal Detachment as a Prodromal Manifestation of Differentiation Syndrome in Acute Promyelocytic Leukemia: A Case Report and Review of Literature. J Biomed Res Environ Sci. 2023 Nov 23; 4(11): 1601-1606. doi: 10.37871/jbres1836, Article ID: JBRES1836, Available at: https://www.jelsciences.com/ articles/jbres1836.pdf
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References
- Yilmaz M, Kantarjian H, Ravandi F. Acute promyelocytic leukemia current treatment algorithms. Blood Cancer J. 2021;11(6):123. doi: 10.1038/s41408-021-00514-3.
- Grimwade D, Lo Coco F. Acute promyelocytic leukemia: a model for the role of molecular diagnosis and residual disease monitoring in directing treatment approach in acute myeloid leukemia. Leukemia. 2002 Oct;16(10):1959-73. doi: 10.1038/sj.leu.2402721. PMID: 12357347.
- Zhu HH, Hu J, Lo-Coco F, Jin J. The simpler, the better: oral arsenic for acute promyelocytic leukemia. Blood. 2019 Aug 15;134(7):597-605. doi: 10.1182/blood.2019000760. Epub 2019 May 21. PMID: 31113776.
- Rego EM, De Santis GC. Differentiation syndrome in promyelocytic leukemia: clinical presentation, pathogenesis and treatment. Mediterr J Hematol Infect Dis. 2011;3(1):e2011048. doi: 10.4084/MJHID.2011.048. Epub 2011 Oct 24. PMID: 22110898; PMCID: PMC3219650.
- Stahl M, Tallman MS. Acute promyelocytic leukemia (APL): remaining challenges towards a cure for all. Leuk Lymphoma. 2019 Dec;60(13): 3107-3115. doi: 10.1080/10428194.2019.1613540.
- Lehmann S, Ravn A, Carlsson L, Antunovic P, Deneberg S, Möllgård L, Derolf AR, Stockelberg D, Tidefelt U, Wahlin A, Wennström L, Höglund M, Juliusson G. Continuing high early death rate in acute promyelocytic leukemia: a population-based report from the Swedish Adult Acute Leukemia Registry. Leukemia. 2011 Jul;25(7):1128-34. doi: 10.1038/leu.2011.78. Epub 2011 Apr 19. PMID: 21502956.
- Nowak D, Stewart D, Koeffler HP. Differentiation therapy of leukemia: 3 decades of development. Blood. 2009 Apr 16;113(16):3655-65. doi: 10.1182/blood-2009-01-198911. Epub 2009 Feb 12. PMID: 19221035; PMCID: PMC2943835.
- Soignet SL, Frankel SR, Douer D, Tallman MS, Kantarjian H, Calleja E, Stone RM, Kalaycio M, Scheinberg DA, Steinherz P, Sievers EL, Coutré S, Dahlberg S, Ellison R, Warrell RP Jr. United States multicenter study of arsenic trioxide in relapsed acute promyelocytic leukemia. J Clin Oncol. 2001 Sep 15;19(18):3852-60. doi: 10.1200/JCO.2001.19.18.3852. PMID: 11559723.
- Wang G, Li W, Cui J, Gao S, Yao C, Jiang Z, Song Y, Yuan CJ, Yang Y, Liu Z, Cai L. An efficient therapeutic approach to patients with acute promyelocytic leukemia using a combination of arsenic trioxide with low-dose all-trans retinoic acid. Hematol Oncol. 2004 Jun;22(2):63-71. doi: 10.1002/hon.728. PMID: 15468344.
- de la Serna J, Montesinos P, Vellenga E, Rayón C, Parody R, León A, Esteve J, Bergua JM, Milone G, Debén G, Rivas C, González M, Tormo M, Díaz-Mediavilla J, González JD, Negri S, Amutio E, Brunet S, Lowenberg B, Sanz MA. Causes and prognostic factors of remission induction failure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and idarubicin. Blood. 2008 Apr 1;111(7):3395-402. doi: 10.1182/blood-2007-07-100669. Epub 2008 Jan 14. PMID: 18195095.
- Luesink M, Pennings JL, Wissink WM, Linssen PC, Muus P, Pfundt R, de Witte TJ, van der Reijden BA, Jansen JH. Chemokine induction by all-trans retinoic acid and arsenic trioxide in acute promyelocytic leukemia: triggering the differentiation syndrome. Blood. 2009 Dec 24;114(27):5512-21. doi: 10.1182/blood-2009-02-204834. Epub 2009 Oct 14. PMID: 19828696.
- Levasseur SD, Tantiworawik A, Lambert Maberley DA. All-trans retinoic Acid differentiation syndrome chorioretinopathy: a case of multifocal serous neurosensory detachments in a patient with acute promyelocytic leukemia treated with all-trans retinoic Acid. Retin Cases Brief Rep. 2013 Winter;7(1):46-9. doi: 10.1097/ICB.0b013e3182618d6c. PMID: 25390520.
- Newman AR, Leung B, Richards A, Campbell TG, Wellwood J, Imrie FR. Two cases of differentiation syndrome with ocular manifestations in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and arsenic trioxide. Am J Ophthalmol Case Rep. 2018 Jan 17;9:106-111. doi: 10.1016/j.ajoc.2018.01.026. PMID: 29468228; PMCID: PMC5790809.
- Hua HU, Rayess N, Moshfeghi AA. Acute Promyelocytic Leukemia With Sudden Vision Loss. JAMA Ophthalmol. 2020 Feb 1;138(2):206-207. doi: 10.1001/jamaophthalmol.2019.4838. PMID: 31804661.
- Tam EK, Ness S, Peeler CE. Exudative hemorrhagic retinopathy related to all-trans retinoic acid differentiation syndrome in a patient with acute promyelocytic leukemia. Int J Ophthalmol. 2021 Feb 18;14(2):323-325. doi: 10.18240/ijo.2021.02.22. PMID: 33614465; PMCID: PMC7840356.
- Gim Y, Kim HJ. Ocular Symptom Can Be the First Presentation of Differentiation Syndrome in Acute Promyelocytic Leukemia. Korean J Ophthalmol. 2021 Feb;35(1):94-96. doi: 10.3341/kjo.2020.0101. Epub 2020 Dec 11. PMID: 33307628; PMCID: PMC7904416.