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Acute Promyelocytic Leukemia and Severe Differentiation Syndrome in Pregnancy—A Management Challenge

Acute promyelocytic leukemia (APL) is generated by the PML-RARA fusion gene. In patients suffering from APL, the early diagnosis and treatment are essential in the successful management. We reported a case of a 27-year-old 17th-week pregnant patient diagnosed with APL. After an extensive hematologic...

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Autores principales: Droc, Gabriela, Stancioaica, Maria Camelia, Soare, Corina Gabriela, Stefan, Mihai-Gabriel, Ingustu, Daiana, Martac, Cristina, Coriu, Daniel, Isac, Sebastian, Suciu, Nicolae, Andrei, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10221439/
https://www.ncbi.nlm.nih.gov/pubmed/37240786
http://dx.doi.org/10.3390/life13051141
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author Droc, Gabriela
Stancioaica, Maria Camelia
Soare, Corina Gabriela
Stefan, Mihai-Gabriel
Ingustu, Daiana
Martac, Cristina
Coriu, Daniel
Isac, Sebastian
Suciu, Nicolae
Andrei, Stefan
author_facet Droc, Gabriela
Stancioaica, Maria Camelia
Soare, Corina Gabriela
Stefan, Mihai-Gabriel
Ingustu, Daiana
Martac, Cristina
Coriu, Daniel
Isac, Sebastian
Suciu, Nicolae
Andrei, Stefan
author_sort Droc, Gabriela
collection PubMed
description Acute promyelocytic leukemia (APL) is generated by the PML-RARA fusion gene. In patients suffering from APL, the early diagnosis and treatment are essential in the successful management. We reported a case of a 27-year-old 17th-week pregnant patient diagnosed with APL. After an extensive hematological diagnostic panel, the acute promyelocytic leukemia was confirmed, and the patient received all-trans retinoic acid (ATRA), idarubicin (IDA), and dexamethasone, following national guidelines. Due to ATRA-related differentiation syndrome, the therapy was adjusted, and hydroxycarbamide was added with a good outcome. The patient was admitted to the ICU secondary to hypoxemic respiratory failure on the 2nd day after hospital admission. Our patient received an individualized drug combination, adjusted by the clinical response. Furthermore, the drugs used in APL treatment are all teratogenic. Despite various major complications, including severe acute respiratory distress syndrome (ARDS), which needed mechanical ventilation; ICU-acquired myopathy; and spontaneous abortion, the patient had a good outcome and was transferred from the ICU after a total stay of 40 days. APL during pregnancy is a rare entity of intermediate-risk APL. Our study emphasized the need for individualized therapy in a rare case of a pregnant woman diagnosed with a potentially fatal hematologic disease.
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spelling pubmed-102214392023-05-28 Acute Promyelocytic Leukemia and Severe Differentiation Syndrome in Pregnancy—A Management Challenge Droc, Gabriela Stancioaica, Maria Camelia Soare, Corina Gabriela Stefan, Mihai-Gabriel Ingustu, Daiana Martac, Cristina Coriu, Daniel Isac, Sebastian Suciu, Nicolae Andrei, Stefan Life (Basel) Case Report Acute promyelocytic leukemia (APL) is generated by the PML-RARA fusion gene. In patients suffering from APL, the early diagnosis and treatment are essential in the successful management. We reported a case of a 27-year-old 17th-week pregnant patient diagnosed with APL. After an extensive hematological diagnostic panel, the acute promyelocytic leukemia was confirmed, and the patient received all-trans retinoic acid (ATRA), idarubicin (IDA), and dexamethasone, following national guidelines. Due to ATRA-related differentiation syndrome, the therapy was adjusted, and hydroxycarbamide was added with a good outcome. The patient was admitted to the ICU secondary to hypoxemic respiratory failure on the 2nd day after hospital admission. Our patient received an individualized drug combination, adjusted by the clinical response. Furthermore, the drugs used in APL treatment are all teratogenic. Despite various major complications, including severe acute respiratory distress syndrome (ARDS), which needed mechanical ventilation; ICU-acquired myopathy; and spontaneous abortion, the patient had a good outcome and was transferred from the ICU after a total stay of 40 days. APL during pregnancy is a rare entity of intermediate-risk APL. Our study emphasized the need for individualized therapy in a rare case of a pregnant woman diagnosed with a potentially fatal hematologic disease. MDPI 2023-05-08 /pmc/articles/PMC10221439/ /pubmed/37240786 http://dx.doi.org/10.3390/life13051141 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Droc, Gabriela
Stancioaica, Maria Camelia
Soare, Corina Gabriela
Stefan, Mihai-Gabriel
Ingustu, Daiana
Martac, Cristina
Coriu, Daniel
Isac, Sebastian
Suciu, Nicolae
Andrei, Stefan
Acute Promyelocytic Leukemia and Severe Differentiation Syndrome in Pregnancy—A Management Challenge
title Acute Promyelocytic Leukemia and Severe Differentiation Syndrome in Pregnancy—A Management Challenge
title_full Acute Promyelocytic Leukemia and Severe Differentiation Syndrome in Pregnancy—A Management Challenge
title_fullStr Acute Promyelocytic Leukemia and Severe Differentiation Syndrome in Pregnancy—A Management Challenge
title_full_unstemmed Acute Promyelocytic Leukemia and Severe Differentiation Syndrome in Pregnancy—A Management Challenge
title_short Acute Promyelocytic Leukemia and Severe Differentiation Syndrome in Pregnancy—A Management Challenge
title_sort acute promyelocytic leukemia and severe differentiation syndrome in pregnancy—a management challenge
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10221439/
https://www.ncbi.nlm.nih.gov/pubmed/37240786
http://dx.doi.org/10.3390/life13051141
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