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Blood, 22 January 2009, Vol. 113, No. 4, pp. 775-783. Prepublished online as a Blood First Edition Paper on October 22, 2008; DOI 10.1182/blood-2008-07-168617. This Article Full Text Full Text (PDF) Supplemental Appendix All Versions of this Article: blood-2008-07-168617v1 113/4/775    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Montesinos, P. Articles by Sanz, M. A. Search for Related Content PubMed PubMed Citation Articles by Montesinos, P. Articles by Sanz, M. A. Related Collections Free Research Articles Myeloid Neoplasia Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Differentiation syndrome in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline chemotherapy: characteristics, outcome, and prognostic factors Pau Montesinos1,2, Juan M. Bergua3, Edo Vellenga4, Chelo Rayón5, Ricardo Parody6, Javier de la Serna7, Angel León8, Jordi Esteve9, Gustavo Milone10, Guillermo Debén11, Concha Rivas12, Marcos González13, Mar Tormo14, Joaquín Díaz-Mediavilla15, Jose D. González16, Silvia Negri17, Elena Amutio18, Salut Brunet19, Bob Lowenberg20, and Miguel A. Sanz1 1 Hospital Universitario La Fe, Valencia, Spain; 2 Department of Medicine of the Universitat Autònoma de Barcelona, Barcelona, Spain; 3 Hospital San Pedro de Alcántara, Cáceres, Spain; 4 University Hospital, Groningen, The Netherlands; 5 Hospital Central de Asturias, Oviedo, Spain; 6 Hospital Universitario Virgen del Rocío, Sevilla, Spain; 7 Hospital 12 de Octubre, Madrid, Spain; 8 Hospital General, Jerez de la Frontera, Spain; 9 Hospital Clinic, Barcelona, Spain; 10 Fundaleu, Buenos Aires, Argentina; 11 Hospital Juan Canalejo, La Coruña, Spain; 12 Hospital General, Alicante, Spain; 13 Hospital Universitario, Salamanca, Spain; 14 Hospital Clínico Universitario, Valencia, Spain; 15 Hospital Clínico San Carlos, Madrid, Spain; 16 Hospital Insular, Las Palmas, Spain; 17 Hospital Carlos Haya, Málaga, Spain; 18 Hospital de Cruces, Baracaldo, Spain; 19 Hospital Sant Pau, Barcelona, Spain; and 20 Erasmus University Medical Center, Rotterdam, The Netherlands Differentiation syndrome (DS) can be a life-threatening complication in patients with acute promyelocytic leukemia (APL) undergoing induction therapy with all-trans retinoic acid (ATRA). Detailed knowledge about DS has remained limited. We present an analysis of the incidence, characteristics, prognostic factors, and outcome of 739 APL patients treated with ATRA plus idarubicin in 2 consecutive trials (Programa Español de Tratamientos en Hematología [PETHEMA] LPA96 and LPA99). Overall, 183 patients (24.8%) experienced DS, 93 with a severe form (12.6%) and 90 with a moderate form (12.2%). Severe but not moderate DS was associated with an increase in mortality. A bimodal incidence of DS was observed, with peaks occurring in the first and third weeks after the start of ATRA therapy. A multivariate analysis indicated that a WBC count greater than 5 x 109/L and an abnormal serum creatinine level correlated with an increased risk of developing severe DS. Patients receiving systematic prednisone prophylaxis (LPA99 trial) in contrast to those receiving selective prophylaxis with dexamethasone (LPA96 trial) had a lower incidence of severe DS. Patients developing severe DS showed a reduced 7-year relapse-free survival in the LPA96 trial (60% vs 85%, P = .003), but this difference was not apparent in the LPA99 trial (86% vs 88%). CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: D. Bonofiglio, E. Cione, H. Qi, A. Pingitore, M. Perri, S. Catalano, D. Vizza, M. L. Panno, G. Genchi, S. A.W. Fuqua, et al. Combined Low Doses of PPAR{gamma} and RXR Ligands Trigger an Intrinsic Apoptotic Pathway in Human Breast Cancer Cells Am. J. Pathol., September 1, 2009; 175(3): 1270 - 1280. [Abstract] [Full Text] [PDF]

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