A Storm Within Remission: Multisystem Complications of All-Trans Retinoic Acid-Arsenic Trioxide Therapy in Acute Promyelocytic Leukemia
Abstract
Shazaf Masood Sidhu, Hafiz Muhammad Hamza, Osman Wafai and Rida Maria
Background: Acute promyelocytic leukemia (APML) is a hematologic emergency with high curative potential when treated with all-trans ret- inoic acid (ATRA) and arsenic trioxide (ATO). However, early-phase induction therapy may be complicated by serious adverse events requiring rapid recognition and management.
Case Presentation: We report the case of a 22 years old woman with newly diagnosed APML who developed multiple life-threatening complica- tions during induction therapy with ATRA and ATO. These included significant QT interval prolongation, severe electrolyte disturbances, focal seizures, pseudo-ischemic chest pain likely due to coronary vasospasm, and dural venous sinus thrombosis (DVST). Temporary discontinuation of therapy, aggressive supportive care, and coordinated multidisciplinary management enabled full recovery and resumption of curative treatment.
Conclusion: This case underscores the importance of close monitoring and individualized, dynamic treatment strategies during ATRA-ATO induction in APML. Clinicians should maintain a high index of suspicion for both common and rare complications such as DVST and ATO-induced vasospasm. Early intervention and multidisciplinary collaboration are essential to safely navigate toxicity while preserving therapeutic efficacy.