J Korean Radiol Soc.  2001 Mar;44(3):339-343. 10.3348/jkrs.2001.44.3.339.

ATRA (all-trans-retinoic acid) Syndrome in Acute Promyelocytic Leukemia: Clinical and Radiologic Findings

• Kim KH
• Goo JM
• Im JG
• Chung MJ
• Do KH
• Seo JB
• Park SY

• KMID: 2200428
• DOI: http://doi.org/10.3348/jkrs.2001.44.3.339

Abstract

PURPOSE: To describe the clinical and radiologic findings of all-trans-retinoic acid (ATRA) syndrome in acute promyelocytic leukemia.
MATERIALS AND METHODS
Among 21 patients with acute promyelocytic leukemia who were treated with all-trans- retinoic acid between 1995 and 1998, we retrospectively evaluated the cases of four with ATRA syn-drome. Two were male and two were female, and their mean age was 58 years. The clinical and radiologic findings of chest radiography (n=4) and HRCT (n=1) were analyzed.
RESULTS
Between seven and 13 days after ATRA treatment, dry cough, dyspnea and high fever developed in all patients. The WBC count in peripheral blood was significantly higher [2.9 -25.3(mean, 10.8)-fold] than before ATRA treatment, and in all patients, chest radiography revealed ill-defined consolidation and pleural effu-sion. Kerley 's B line (n=3) and hilar enlargement (n=3) were also seen, and in one patient, HRCT demonstrated septal line thickening. Among four patients treated with prednisolone and Ara-C,three recovered and one
CONCLUSION
In acute promyelocytic patients treated with all-trans-retinoic acid, radiologic findings of ill-de-fined consolidation, pleural effusion, hilar prominence and Kerley 's B line may suggest ATRA syndrome. The early diagnosis of this will improve the patients' prognosis.

Keyword

Lung, radiography; Lung, effects of drugs on

MeSH Terms

Cough
Dyspnea
Early Diagnosis
Female
Fever
Humans
Leukemia, Promyelocytic, Acute*
Male
Pleural Effusion
Prednisolone
Prognosis
Radiography
Retrospective Studies
Thorax
Tretinoin
Prednisolone
Tretinoin