All trans retinoic acid induced hypercalcemia and diffuse alveolar hemorrhage in acute promyelocytic leukemia: Practical guidelines for diagnosis and treatment based on a case report and literature review

As experience with all trans-retinoic acid (ATRA) in acute promyelocytic leukemia (APL) has grown, its’ toxicity profile became more extensive. We initially present a case of APL in which hypercalcemia and Diffuse Alveolar Hemorrhage occurred simultaneously after introduction of ATRA, followed by a systematic review of the literature. A comity of 5 specialists analyzed and discussed each reported case on the basis of the CAse REport (CARE) guidelines. Level III guides were suggested for diagnosis and treatment.