Supportive measures are also crucial in the correct management of differentiation syndrome. In the PETHEMA protocols, furosemide is usually administered to treat signs or symptoms of fluid overload. Some cases with refractory acute renal failure and/or fluid overload may need renal replacement therapy and in patients at risk for fluid overload and high requirements of blood products to control the coagulopathy, the use of cryoprecipitate, fibrinogen, and other coagulation factor concentrates instead of fresh-frozen plasma may be considered. Invasive, but also noninvasive, mechanical ventilation is indicated in some patients with severe acute respiratory failure who do not respond to high-flow oxygen therapy. In our experience,6 diuretics, dialysis, and mechanical ventilation were needed in 87%, 12%, and 26% of patients with DS,
Sanz MA, Montesinos P. How we prevent and treat differentiation syndrome in patients with acute promyelocytic leukemia. Blood. 2014 May 1;123(18):2777-82. doi: 10.1182/blood-2013-10-512640. Epub 2014 Mar 13.
Differentiation syndrome, formerly known as retinoic acid syndrome, is a relatively common and potentially severe complication seen in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and/or arsenic trioxide. The full-blown syndrome consists of unexplained fever, weight gain, dyspnea with pulmonary infiltrates, pleuropericardial effusion, hypotension, and renal failure. Most measures currently used for management of Differentiation syndrome have very little evidence-based support, and therefore, many remain controversial