Massive pulmonary embolism at the onset of acute promyelocytic leukemia
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Keywords
acute promyelocytic leukemia, pulmonary embolism, thrombolysis, arsenic trioxide.
Abstract
Life-threatening bleeding is a major and early complication of acute promyelocytic leukemia (APL), but in the last years there is a growing evidence of thromboses in APL. We report the first case of a young woman with dyspnea as the first symptom of APL due to massive pulmonary embolism (PE) successfully treated with thrombolysis for PE and heparin. APL has been processed with a combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) obtaining complete remission.
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References
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10. Mitrovic M, Suvajdzic N, Elezovic I, et al.Thrombotic events in acute promyelocytic leukemia. Thromb Res. 2015;4:588-93.
11. Vaid AK, Batra S, Karanth SS, Gupta S. Acute promyelocytic leukemia presenting as pulmonary thromboembolism: Not all APLs bleed. Avicenna J Med. 2015;5:131-3.
2. Choudhry, T.G. DeLoughery.Bleeding and thrombosis in acute promyelocytic leukemia. Am J Hematol, 2012;87, 596–603
3. Lo-Coco F1, Avvisati G, Vignetti M, et al Gruppo Italiano Malattie Ematologiche dell'Adulto; German-Austrian Acute Myeloid Leukemia Study Group; Study Alliance Leukemia.Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med. 2013;369:111-21.
4. Mitrovic M1, Suvajdzic N, Bogdanovic A et al.International Society of Thrombosis and Hemostasis Scoring System for disseminated intravascular coagulation ? 6: a new predictor of hemorrhagic early death in acute promyelocytic leukemia. Med Oncol. 2013;30:478.
5. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schunemann HJ for the American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive Summary: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141:7S-47S
6. Sanz MA1, Montesinos P.How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia. Blood2014 May 1;123:2777-82
7. De Stefano V, Sorà F, Rossi E et al.The risk of thrombosis in patients with acute leukemia: occurrence of thrombosis at diagnosis and during treatment. J Thromb Haemost. 2005 ;3:1985-92.
8. Lo-Coco F, Avvisati G, Vignetti M, et al; Italian GIMEMA Cooperative Group. Front-line treatment of acute promyelocytic leukemia with AIDA induction followed by risk-adapted consolidation for adults younger than 61 years: results of the AIDA-2000 trial of the GIMEMA Group.Blood. 2010 ;116:3171-9.
9. Breccia M, Avvisati G, Latagliata R et al Occurrence of thrombotic events in acute promyelocytic leukemia correlates with consistent immunophenotypic and molecular features.Leukemia. 2007 ;21:79-83
10. Mitrovic M, Suvajdzic N, Elezovic I, et al.Thrombotic events in acute promyelocytic leukemia. Thromb Res. 2015;4:588-93.
11. Vaid AK, Batra S, Karanth SS, Gupta S. Acute promyelocytic leukemia presenting as pulmonary thromboembolism: Not all APLs bleed. Avicenna J Med. 2015;5:131-3.