Abstract
All-trans retinoic acid (ATRA) is known to induce complete remission of acute promyelocytic leukemia (APL) and its use has significantly improved the cure rate of APL. However, ATRA also causes side effects such as differentiation syndrome or intracranial hypertension. In our case, the patient was diagnosed with APL and developed hearing loss thrice while being treated with ATRA. Therefore, we reduced the dose of ATRA instead of stopping it altogether and administered dexamethasone to the patient. A hearing test performed thereafter revealed recovery of hearing. No recurrence of hearing loss occurred after prednisolone and ATRA were combined in the maintenance phase. In conclusion, ATRA-associated hearing loss is reversible, and it is not necessary to stop ATRA. We recommend completion of a randomized clinical trial using dexamethasone in combination with ATRA to prevent hearing loss caused by ATRA.
Highlights
Acute promyelocytic leukemia (APL) is a type of acute myeloid leukemia (AML)
all-trans retinoic acid (ATRA) use is typically and commonly associated with differentiation syndrome (DS), which is caused by an inflammatory response mediated by an ATRA-induced increase in promyelocyte maturation and cytokine expression in APL patients
DS is known to occur in 20–30% of patients undergoing ATRA treatment [2]
Summary
Acute promyelocytic leukemia (APL) is a type of acute myeloid leukemia (AML). The cure rate of APL has improved remarkably since the introduction of all-trans retinoic acid (ATRA) as a treatment [1]. The cure rate of APL has improved remarkably since the introduction of all-trans retinoic acid (ATRA) as a treatment [1]. Hearing impairment during ATRA treatment is rare [3]. 13-year-old patient with APL who developed hearing impairment during ATRA treatment.
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