Acute promyelocytic leukemia other imaging studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shyam Patel [2], Sogand Goudarzi, MD; Grammar Reviewer: Natalie Harpenau, B.S.[3]

Overview

Additional imaging studies that can be useful in acute promyelocytic leukemia include echocardiogram, chest X-ray, and brain MRI.

Acute promyelocytic leukemia other imaging findings

  • Echocardiogram:
    • An echocardiogram is an essential imaging modality in patients with acute promyelocytic leukemia receiving anthracycline chemotherapy.[1]
    • Patients who will be receiving anthracycline-based therapy require a baseline echocardiogram to assess the ejection fraction prior to therapy.[2]
    • Anthracyclines are known to cause cardiac toxicity (specifically cardiomyopathy with cumulative anthracycline doses above 500mg/m2).[3]
    • An echocardiogram should be obtained every three months while on therapy with anthracycline. Echocardiogram applies particularly to cases of high-risk acute promyelocytic leukemia, in which case the standard of care is to give anthracycline along with all-trans retinoic acid.[4]
  • Chest X-ray:
    • Chest radiography is useful in the assessment of differentiation syndrome, which is a therapy-related complication when patients are treated with all-trans retinoic acid. Chest X-ray will show pulmonary infiltrate and/or edema.[5]
  • MRI of the brain:

References

  1. Neilan TG, Coelho-Filho OR, Pena-Herrera D, Shah RV, Jerosch-Herold M, Francis SA; et al. (2012). "Left ventricular mass in patients with a cardiomyopathy after treatment with anthracyclines". Am J Cardiol. 110 (11): 1679–86. doi:10.1016/j.amjcard.2012.07.040. PMC 3496816. PMID 22917553.
  2. McGowan JV, Chung R, Maulik A, Piotrowska I, Walker JM, Yellon DM (February 2017). "Anthracycline Chemotherapy and Cardiotoxicity". Cardiovasc Drugs Ther. 31 (1): 63–75. doi:10.1007/s10557-016-6711-0. PMC 5346598. PMID 28185035.
  3. Rahman AM, Yusuf SW, Ewer MS (2007). "Anthracycline-induced cardiotoxicity and the cardiac-sparing effect of liposomal formulation". Int J Nanomedicine. 2 (4): 567–83. PMC 2676818. PMID 18203425.
  4. Avvisati, G.; Lo-Coco, F.; Paoloni, F. P.; Petti, M. C.; Diverio, D.; Vignetti, M.; Latagliata, R.; Specchia, G.; Baccarani, M.; Di Bona, E.; Fioritoni, G.; Marmont, F.; Rambaldi, A.; Di Raimondo, F.; Kropp, M. G.; Pizzolo, G.; Pogliani, E. M.; Rossi, G.; Cantore, N.; Nobile, F.; Gabbas, A.; Ferrara, F.; Fazi, P.; Amadori, S.; Mandelli, F. (2011). "AIDA 0493 protocol for newly diagnosed acute promyelocytic leukemia: very long-term results and role of maintenance". Blood. 117 (18): 4716–4725. doi:10.1182/blood-2010-08-302950. ISSN 0006-4971.
  5. Xu LM, Zheng YJ, Wang Y, Yang Y, Cao FF, Peng B; et al. (2014). "Celastrol inhibits lung infiltration in differential syndrome animal models by reducing TNF-α and ICAM-1 levels while preserving differentiation in ATRA-induced acute promyelocytic leukemia cells". PLoS One. 9 (8): e105131. doi:10.1371/journal.pone.0105131. PMC 4130635. PMID 25116125.
  6. Montesinos P, Díaz-Mediavilla J, Debén G, Prates V, Tormo M, Rubio V; et al. (2009). "Central nervous system involvement at first relapse in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline monochemotherapy without intrathecal prophylaxis". Haematologica. 94 (9): 1242–9. doi:10.3324/haematol.2009.007872. PMC 2738716. PMID 19608685.

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