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Risk/Benefit Profile of Arsenic Trioxide

^a Acute Care Nurse Practitioner Program (Oncology Subspecialty), School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; ^b Memorial Sloan-Kettering Cancer Center and Department of Medicine, and the Joan and Sanford Weill Medical College of Cornell University, New York, New York, USA

Correspondence: Steven L. Soignet, M.D., Developmental Chemotherapy Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021-6007, USA. Telephone: 212-639-8984; Fax: 212-717-3172; e-mail: soignets{at}mskcc.org

Approximately 20%-30% of patients with acute promyelocytic leukemia (APL) who are treated with the current standard all-trans retinoic acid and anthracycline-based chemotherapy regimen suffer relapse. In the mid-1990s, studies from China reported the effective use of arsenic trioxide in achieving complete remission in patients with APL. In the United States, a multicenter trial of this agent in 40 patients with relapsed APL following conventional therapy confirmed the positive safety and efficacy outcomes of a smaller 12-patient pilot study. Common adverse events were hyperleukocytosis, APL differentiation syndrome, prolonged QT interval on electrocardiogram, skin rash, and hyperglycemia.

Key Words. Arsenic trioxide • Acute promyelocytic leukemia • All-trans retinoic acid • APL differentiation syndrome • Hyperleukocytosis • QT interval

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