Management of suspected differentiation syndrome (refer to Box A)

DS: differentiation syndrome; APL: acute promyelocytic leukemia; AML: acute myeloid leukemia; CBC: complete blood count; CT: computed tomography; BAL: bronchoalveolar lavage; BNP: brain natriuretic peptide; EKG: electrocardiogram; ATRA: all-trans retinoic acid; ATO: arsenic trioxide; IDH: isocitrate dehydrogenase.
* Differentiation agents include ATRA and ATO for APL and IDH inhibitors for AML.
¶ Supportive care may include supplemental oxygen, mechanical ventilation, antibiotics, vasopressors, diuretics, and other care, as clinically indicated.
Δ As examples, improvement in fever, blood pressure, dyspnea, oxygenation.
◊ ATRA/ATO should be discontinued in this setting, but discontinuation of IDH inhibitors is optional because their long half-lives may not affect care in the immediate term.