Akut Promyelositik Lösemili Çocuk Hastada All-Trans-Retinoik Asit Tedavisiyle İlişkili İntrakardiyak Tromboz

Year 2021, Volume: 4 Issue: 2, 81 - 86, 21.06.2021

Aylin Canbolat , Ahmet Baysal Öykü Tosun

Abstract

Ölümcül koagulopatiler ve hemorajiler akut promiyelositik lösemide (APL) indüksiyon tedavisine yanıt alınamamasının temel sebeplerini oluşturmaktadır. Ağır trombotik olaylar genellikle tanı sırasında ya da tedavinin kilit noktasını oluşturan all-trans-retinoik asit (ATRA) ile remisyon indüksiyon tedavisine başlanmasından hemen sonra gelişir. Diğer yandan izole sağ ventrikül içi tromboz hayatı tehdit edici bir patoloji olup kanser hastalarında nadir olarak saptanmıştır. Bu çalışmada remisyonda iken sağ ventriküler kardiyak trombüs gelişen dokuz yaşındaki APL olgusu nadir görülmesi nedeniyle sunulmuştur. ATRA’nın yan etkilerinin öneminin gösterilmesi, ölümcül olabilen komplikasyonların vurgulanması amaçlanmıştır. Trombozun sadece diferansiyasyon sendromunu sırasında değil tedavinin her döneminde gelişebileceği akılda tutulmalıdır.

Keywords

Akut promiyelositik lösemi, All-Trans-Retinoik Asit, İntrakardiyak tromboz

Intracardiac Thrombus Associated with All-Trans-Retinoic Acid Treatment in a Child with Acute Promyelocytic Leukemia

Abstract

In acute promyelocytic leukemia (APL) potentially fatal coagulopathy and hemorrhages remain major causes of induction failure. Serious thrombotic events are frequently reported at the diagnosis or following remission induction therapy with all-trans-retinoic acid (ATRA), which is a key point in treatment of APL. On the other hand, isolated right ventricular (RV) thrombus is a life-threatening condition and in cancer patients it has been rarely reported. In this report, we have described a very rare a case of ATRA-related isolated right-sided intracardiac thrombus in a nine-year-old child with APL that developed after achievement of complete remission, during the 4th course of ATRA, which is an unexpected period for ATRA-related thrombotic events. We aimed to emphasize the importance of side effects of ATRA and increase awareness against such life-threatening complications. Thrombosis mustn’t be expected only during differentiation syndrome; it should be kept in mind in every phase of treatment with ATRA.

Keywords

Acute promyelocytic leukemia, All-trans-retinoic acid, Intracardiac thrombus

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