Repeat pregnancy testing monthly throughout therapy. Advise patient to avoid pregnancy. Instruct patient to use 2 reliable contraceptive methods simultaneously during therapy and for 1 mo following discontinuation. Contraception must be used even when there is a history of infertility or menopause, unless a hysterectomy has been performed. Base therapy on morphological diagnosis of acute promyelocytic leukemia.
Drug is contraindicated in patients with a known hypersensitivity to retinoids.
Syndrome has occasionally been accompanied by impaired myocardial contractility and episodic hypotension and has been observed with or without concomitant leukocytosis. Endotracheal intubation and mechanical ventilation have been needed due to progressive hypoxemia, and several patients have expired with multiorgan failure. Syndrome generally occurs during first month of treatment, sometimes following first dose. Majority of patients do not require discontinuation. Patient who present with high WBC count at diagnosis have an increased risk of further rapid increase in WBC counts.