Pediatric Use: In a pediatric study, the toxicity profile observed in 13 pediatric patients with APL between the ages of 4 and 20 receiving TRISENOX was similar to that observed in adult patients. Additional drug-related toxicities reported included: gastrointestinal disorders, metabolic and nutrition disorders, respiratory disorders, cardiac failure congestive, neuralgia, and enuresis. One case each of pulmonary edema and caecitis were considered serious reactions. No children less than 4 years of age were enrolled in the trial due to the rarity of APL in this age group.
This increase in leukocyte (primarily neutrophils) is usually accompanied by a "left upper shift" in the ratio of immature to mature neutrophils and macrophages. The proportion of immature leukocytes decreases due to proliferation and inhibition of granulocyte and monocyte precursors in the bone marrow which is stimulated by several products of inflammation including C3a and G-CSF. Although it may indicate illness, leukocytosis is considered a laboratory finding instead of a separate disease . This classification is similar to that of fever , which is also a test result instead of a disease. [ citation needed ] "Right shift" in the ratio of immature to mature neutrophils is considered with reduced count or lack of "young neutrophils" (metamyelocytes, and band neutrophils ) in blood smear , associated with the presence of "giant neutrophils". This fact shows suppression of bone marrow activity, as a hematological sign specific for pernicious anemia and radiation sickness . 
For patients with chronic disease (persistent disease activity 12 months after diagnosis), weekly oral methotrexate has been used to limit steroid use. Other second line drugs, such as IM gold, D-penicillamine, hydroxychloroquine and azathioprine, have been used as well. Cyclophosphamide, because of its toxicity, should be reserved for the most exceptional cases. Lastly, the role of anti-TNF therapy in the treatment of adult Still’s disease refractory to conventional therapy appears promising10 but further studies to evaluate the long-term safety and efficacy are needed.