Severe Symptoms of Hyperhistaminemia after the Treatment of Acute Promyelocytic Leukemia with Tretinoin (all-transRetinoic Acid)

Koike, Tadashi; Tatewaki, Wataru; Aoki, Azusa; Yoshimoto, Haruko; Yagisawa, Kumiko; Hashimoto, Shigeo; Furukawa, Tatsuo; Saitoh, Hiroyuki; Takahashi, Masuhiro; Yang, Libo; Wang, Ying; Shibata, Akira

doi:10.1056/nejm199208063270604

Cited by 48 publications

(17 citation statements)

References 9 publications

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“…In addition, a t(15;17) translocation is found in more than 90% of the cases of APL [12], The leukemic cells in our patient had the same characteristic features as those of typical APL. However, heterogeneity of leukemic promyelocytes has been described and in a few patients leukemic promyelocytes have contained granules similar to those of basophils [1][2][3][4], The granules are known to show a metachromatic reaction with toluidine blue. In fact, about one third of the blasts in our patient had cy tologic features of basophilic differentiation and showed a metachromatic reaction with toluidine blue.…”

Section: Discussionmentioning

confidence: 99%

“…receptors, and gastric hyperchlorhydria and increased atrial rate, mediated via H2 receptors [16,17]. Recently, severe symptoms of hyperhistaminemia have been rerported [3] after the treatment of APL with basophilia by all-tram retinoic acid. Therefore, we could expect hyperhistaminemia in our patient since he had mild basophilia and his leukemic promyelocytes had cytologic features of basophilic differentiation.…”

Section: Discussionmentioning

confidence: 99%

“…Sixty milligrams of all-tran s retinoic acid per day was started in February 1993. A histamine H,-receptor antagonist, famo tidine (40 mg/day), was administered intravenously as he had mclena, and severe symptoms of hyperhistaminemia were reported after the treatment of APL with cytologic features of basophilic differentia tion [3], There was a gradual increase in basophils, but the patient felt well during the first week of drug administration. The leukocyte, ab solute basophil, and absolute neutrophil counts rose to maximal lev els of 22.3 x 1071, 3.9 x 1071, and 8.2 x 1071 on the 20th day of all-tramretinoic acid treatment.…”

Section: Case Reportmentioning

confidence: 99%

“…However, heteroge neity of leukemic promyelocytes has recently been de scribed and it has been reported that in a few patients, leu kemic promyelocytes contained granules similar to those of basophils [1,2], More recently, marked basophilia and severe symptoms (shock and ulceration of stomach and duodenum) due to hyperhistaminemia have been ob served during the administration of all-trans retinoic acid [3,4], All-/raus retinoic acid is known to induce the matura tion of leukemic cells in vitro and in vivo. It has widely been applied to the patients with APL in these days and Yoshinori Shimamoto.…”

Section: Introductionmentioning

confidence: 99%

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Prophylaxis of Symptoms of Hyperhistaminemia after the Treatment of Acute Promyelocytic Leukemia with All-Trans Retinoic Acid

et al. 1994

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A 61-year-old man with acute promyelocytic leukemia (APL) is described in whom some leukemic promyelocytes contained granules similar to those of basophils, and hyperhistaminemia developed after treatment with all-trans retinoic acid. The symptoms of hyperhistaminemia, mediated via H₂ receptors, were prevented by the administration of an H₂-blocker, famotidine, but wheezing due to bronchospasms, mediated via H₁ receptors, developed and was improved by administration of chlorpheniramine. In APL, it is generally thought that the maturation of neutrophilic leukocytes is arrested at the level of abnormal promyelocytes. However, heterogeneity of leukemic promyelocytes has been described and in a few patients some leukemic promyelocytes have been known to show basophilic features. Marked basophilia and severe symptoms due to hyperhistaminemia have recently been reported after the treatment of APL with ali-trans retinoic acid. Our case presented similar basophilic features, but indicated that the symptoms of hyperhistaminemia after administration of retinoic acid can be prevented with antihistaminic drugs and suggested that both H₁ and H₂- blockers should be administered to such APL patients with basophilia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prophylaxis of Symptoms of Hyperhistaminemia after the Treatment of Acute Promyelocytic Leukemia with All-Trans Retinoic Acid

et al. 1994

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“…however, very rare but more important side effects have been reported: cutaneous rashes in a few patients [26], erythema nodosum (at least in 3 patients), hypercalcemia (in 2 patients) [26. 27], thromboembolic events (in 1 patient) [28], hyperhistaminemia leading to shock (in 1 patient) [29].…”

Section: Side Effects O F a Tr A Are Usually Moderatementioning

confidence: 99%

The Role of All-Trans-Retinoic Acid in the Treatment of Acute Promyelocytic Leukemia

Fenaux¹

1993

Acta Haematol

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All-trans-retinoic acid (ATRA) has demonstrated in vivo and in vitro that it could differentiate leukemic cells in acute promyelocytic leukemia (APL). ATRA yields complete remission (CR) rates of approximately 90% in newly diagnosed and first relapsing APL, in APL resistant to one or two courses of chemotherapy, whereas patients in second and subsequent remissions often have only partial remissions. The use of ATRA in APL is associated with two major drawbacks: (1) the risk of rapidly rising leukocyte counts, leading to the ‘retinoic acid syndrome’ which may be fatal if the increase in leukocytes is not reversed and (2) almost universal relapse, if no intensive chemotherapy is administered after CR achievement. Preliminary results, however, suggest that ATRA followed by intensive chemotherapy has improved the outcome of newly diagnosed APL, by slightly increasing the CR rate but also by reducing the risk of relapse, as compared to chemotherapy alone.

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Acute Leukaemia: Cytology, Cytochemistry and the FAB Classification

Bain¹

2007

Leukaemia Diagnosis

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Severe Symptoms of Hyperhistaminemia after the Treatment of Acute Promyelocytic Leukemia with Tretinoin (all-transRetinoic Acid)

Cited by 48 publications

References 9 publications

Prophylaxis of Symptoms of Hyperhistaminemia after the Treatment of Acute Promyelocytic Leukemia with <i>All-Tran</i><i>s</i> Retinoic Acid

Prophylaxis of Symptoms of Hyperhistaminemia after the Treatment of Acute Promyelocytic Leukemia with <i>All-Tran</i><i>s</i> Retinoic Acid

The Role of All-<i>Tran</i><i>s</i>-Retinoic Acid in the Treatment of Acute Promyelocytic Leukemia

Acute Leukaemia: Cytology, Cytochemistry and the FAB Classification

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