Acute promyelocytic leukemia other imaging studies: Difference between revisions
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**[[Patient|Patients]] who will be receiving [[anthracycline]]-based [[therapy]] require a baseline [[echocardiogram]] to assess the [[ejection fraction]] prior to [[therapy]].<ref name="pmid28185035">{{cite journal |vauthors=McGowan JV, Chung R, Maulik A, Piotrowska I, Walker JM, Yellon DM |title=Anthracycline Chemotherapy and Cardiotoxicity |journal=Cardiovasc Drugs Ther |volume=31 |issue=1 |pages=63–75 |date=February 2017 |pmid=28185035 |pmc=5346598 |doi=10.1007/s10557-016-6711-0 |url=}}</ref> | **[[Patient|Patients]] who will be receiving [[anthracycline]]-based [[therapy]] require a baseline [[echocardiogram]] to assess the [[ejection fraction]] prior to [[therapy]].<ref name="pmid28185035">{{cite journal |vauthors=McGowan JV, Chung R, Maulik A, Piotrowska I, Walker JM, Yellon DM |title=Anthracycline Chemotherapy and Cardiotoxicity |journal=Cardiovasc Drugs Ther |volume=31 |issue=1 |pages=63–75 |date=February 2017 |pmid=28185035 |pmc=5346598 |doi=10.1007/s10557-016-6711-0 |url=}}</ref> | ||
**[[Anthracycline|Anthracyclines]] are known to cause [[cardiac]] [[toxicity]] (specifically [[cardiomyopathy]] with cumulative [[anthracycline]] [[Dose|doses]] above 500mg/m2). 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]]. | **[[Anthracycline|Anthracyclines]] are known to cause [[cardiac]] [[toxicity]] (specifically [[cardiomyopathy]] with cumulative [[anthracycline]] [[Dose|doses]] above 500mg/m2). 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]]. | ||
*'''Chest X-ray''': [[Chest radiography]] is useful in the assessment of [[differentiation]] [[syndrome]], which is a [[therapy]]-related [[Complication (medicine)|complication]] when [[Patient|patients]] are treated with all-''[[trans]]'' [[retinoic acid]]. [[Chest X-ray]] will show [[pulmonary]] infiltrate and/or [[edema]].<ref name="pmid25116125">{{cite journal| author=Xu LM, Zheng YJ, Wang Y, Yang Y, Cao FF, Peng B et al.| title=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. | journal=PLoS One | year= 2014 | volume= 9 | issue= 8 | pages= e105131 | pmid=25116125 | doi=10.1371/journal.pone.0105131 | pmc=4130635 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25116125 }} </ref> | *'''Chest X-ray''': | ||
**[[Chest radiography]] is useful in the assessment of [[differentiation]] [[syndrome]], which is a [[therapy]]-related [[Complication (medicine)|complication]] when [[Patient|patients]] are treated with all-''[[trans]]'' [[retinoic acid]]. [[Chest X-ray]] will show [[pulmonary]] infiltrate and/or [[edema]].<ref name="pmid25116125">{{cite journal| author=Xu LM, Zheng YJ, Wang Y, Yang Y, Cao FF, Peng B et al.| title=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. | journal=PLoS One | year= 2014 | volume= 9 | issue= 8 | pages= e105131 | pmid=25116125 | doi=10.1371/journal.pone.0105131 | pmc=4130635 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25116125 }} </ref> | |||
*'''MRI of the brain''': | *'''MRI of the brain''': | ||
**In rare cases, acute promyelocytic leukemia can present with [[central nervous system]] deficits.<ref name="pmid19608685">{{cite journal| author=Montesinos P, Díaz-Mediavilla J, Debén G, Prates V, Tormo M, Rubio V et al.| title=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. | journal=Haematologica | year= 2009 | volume= 94 | issue= 9 | pages= 1242-9 | pmid=19608685 | doi=10.3324/haematol.2009.007872 | pmc=2738716 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19608685 }} </ref> | **In rare cases, acute promyelocytic leukemia can present with [[central nervous system]] deficits.<ref name="pmid19608685">{{cite journal| author=Montesinos P, Díaz-Mediavilla J, Debén G, Prates V, Tormo M, Rubio V et al.| title=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. | journal=Haematologica | year= 2009 | volume= 94 | issue= 9 | pages= 1242-9 | pmid=19608685 | doi=10.3324/haematol.2009.007872 | pmc=2738716 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19608685 }} </ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [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). 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.
- 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.[3]
- MRI of the brain:
- In rare cases, acute promyelocytic leukemia can present with central nervous system deficits.[4]
- MRI of the brain is a useful to assess for lesions of the gray or white matter. MRI is the brain should be done if a patient has neurological deficits.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.