Pseudotumor cerebri after treatment of relapsed acute promyelocytic leukemia with arsenic trioxide

Galm, Oliver; Fabry, U.; Osieka, R.

doi:10.1038/sj.leu.2401671

Cited by 22 publications

(7 citation statements)

References 8 publications

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“…If the reduced dose is well tolerated, gradual escalation to the full dose should be attempted. This complication has also been associated with ATO (Galm et al, 2000). Because azole antifungal agents inhibit cytochrome P-450 mediated ATRA catabolism, their concomitant use with ATRA may increase ATRA plasma levels, increasing the risk of PTC and nephrotoxicity (Yarali et al, 2008).…”

Section: Atra Neurotoxicitymentioning

confidence: 99%

How I treat children and adolescents with acute promyelocytic leukaemia

Abla

Ribeiro

2013

Br J Haematol

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Summary Acute promyelocytic leukaemia (APL) is a rare subtype of acute myeloid leukaemia. The outcome of paediatric APL has improved substantially over the past 20 years; cure rates above 80% are expected when all-trans retinoic acid (ATRA) is given with anthracycline-based regimens. The presenting features of paediatric APL may include severe bleeding and thrombotic complications, which contribute to the high early death rate. The incidence of leucocytosis and the microgranular subtype is greater in paediatric than adult APL, and children experience greater ATRA-related toxicity. It is crucial to begin ATRA therapy and intensive platelet and fibrinogen replacement on first suspicion of APL. Recent risk-adapted therapeutic trials have shown that patients at greater risk of relapse benefit from the introduction of high-dose cytarabine during consolidation. Combination therapy with ATRA and arsenic trioxide provides very effective frontline treatment and may reduce the need for subsequent anthracycline therapy.

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Section: Atra Neurotoxicitymentioning

confidence: 99%

How I treat children and adolescents with acute promyelocytic leukaemia

Abla

Ribeiro

2013

Br J Haematol

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“…Given the remarkable incidence of PTC in our patients receiving ATO-ATRA, it is possible that ATO may foster the development of this condition in APL patients. PTC has been reported previously in a 21-year old woman receiving ATO consolidation therapy for APL without concurrent ATRA [35]. The mechanism for ATO induced PTC has not been identified.…”

Section: Discussionmentioning

confidence: 86%

High pseudotumor cerebri incidence in tretinoin and arsenic treated acute promyelocytic leukemia and the role of topiramate after acetazolamide failure

Smith

Griffiths

Thompson

et al. 2014

Leukemia Research Reports

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Dual differentiation therapy with arsenic trioxide and tretinoin (all-trans-retinoic acid; ATRA) for the management of low and intermediate risk acute promyelocytic leukemia has recently been recommended by the National Comprehensive Cancer Network. Some less common toxicities of the combination may have yet to be fully realized. Of ten patients we have treated thus far, five (50%) have developed pseudotumor cerebri. In one patient, temporary discontinuation of ATRA and initiation of acetazolamide controlled symptoms. In four patients, topiramate was substituted for acetazolamide to relieve symptoms and allow ATRA dose re-escalation. We conclude that providers should monitor for pseudotumor cerebri and consider topiramate if acetazolamide fails.

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“…Literature reviews reveal numerous cases associated with withdrawal of steroid as causative factor [6,7]. There are also numerous reports, mainly in adults, with myeloid leukemia developing this condition [8,9]. Chemotherapy agents reported to cause benign intracranial hypertension include busulfan with cyclophosphamide, and the combination of vinblastine, cisplatin, and bleomycin [10,11].…”

Section: Discussionmentioning

confidence: 99%

Benign Intracranial Hypertension in Association with Acute Lymphoblastic Leukemia

Sastry¹,

Karandikar²,

English³

2003

Pediatric Hematology and Oncology

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Benign intracranial hypertension, also known as pseudotumor cerebri, is a headache syndrome characterized by (1) raised cerebrospinal fluid (CSF) pressure in the absence of an intracranial mass lesion or ventricular dilatation; (2) normal spinal fluid composition; (3) usually normal findings on neurological examination, except for papilloedema and an occasional VI nerve palsy; and (4) normal level of consciousness [1]. It is an uncommon condition in childhood, presenting once or twice a year in a large referral hospital. Although described as benign, the condition can disrupt normal life and cause significant visual failure. Early recognition and management may help alleviate symptoms and preserve vision. We report a case of 14-year-old boy with T-cell acute lymphoblastic leukemia who developed pseudotumor cerebri during the consolidation phase of treatment. CASE REPORTOur patient was a 14-year-old boy first seen in December 2000 with a history of generalized lymphadenopathy and weight loss. Examination revealed significant cervical lymphadenopathy and pallor. Full blood count at diagnosis revealed hemoglobin of 13.1 g/L, white cell count of 19 × 10 9 /L, and a platelet count of 85 × 10 9 /L. Peripheral blood smear revealed blast cells, and bone marrow examination confirmed the diagnosis of acute lymphoblastic leukemia and immunophenotyping confirmed it to be T-cell leukemia. All parts of his coagulation profile, including a prothrombin time, activated partial thromboplastin time, thrombin time, and serum fibrinogen, were all within normal limits. He was commenced on chemotherapy according to Regimen B of MRC ALL 97/99 protocol. He tolerated the initial induction chemotherapy (weeks 1-4) well. This included prednisolone (40 mg/m 2 ) for

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Pseudotumor cerebri after treatment of relapsed acute promyelocytic leukemia with arsenic trioxide

Cited by 22 publications

References 8 publications

How I treat children and adolescents with acute promyelocytic leukaemia

How I treat children and adolescents with acute promyelocytic leukaemia

High pseudotumor cerebri incidence in tretinoin and arsenic treated acute promyelocytic leukemia and the role of topiramate after acetazolamide failure

Benign Intracranial Hypertension in Association with Acute Lymphoblastic Leukemia

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