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Journal of Medical Case Reports

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Open Access 01-12-2012 | Case report

Relapsed acute promyelocytic leukemia in a hemodialysis-dependent patient treated with arsenic trioxide: a case report

Authors: Gregory S Emmons, Richard H Steingart, James A Stewart, Wilson C Mertens

Published in: Journal of Medical Case Reports | Issue 1/2012

Abstract

Introduction

In the relapsed setting, arsenic trioxide remains the backbone of treatment. Scant literature exists regarding treatment of relapsed acute promyelocytic leukemia in patients with renal failure. To the best of our knowledge we are the first to report a safe and effective means of treatment for relapsed acute promyelocytic leukemia in the setting of advanced renal failure, employing titration of arsenic trioxide based on clinical parameters rather than arsenic trioxide levels.

Case presentation

A 33-year-old Caucasian man with a history of acute promyelocytic leukemia in remission for 3 years, as well as dialysis-dependent chronic renal failure secondary to a solitary kidney and focal segmental glomerulosclerosis and human immunodeficiency virus infection, receiving highly active antiretroviral therapy presented to our hospital with bone marrow biopsy-confirmed relapsed acute promyelocytic leukemia. Arsenic trioxide was begun at a low dose with dose escalation based only on side effect profile monitoring and not laboratory testing for induction as well as maintenance without undue toxicity. Our patient achieved and remains in complete hematologic and molecular remission as of this writing.

Conclusion

Arsenic trioxide can be used safely and effectively to treat acute promyelocytic leukemia in patients with advanced renal failure using careful monitoring of side effects rather than blood levels of arsenic to guide therapeutic dosing.

Antman KH: Introduction: the history of arsenic trioxide in cancer therapy. Oncologist. 2001, 6 (suppl 2): 1-2.CrossRefPubMed

Niu C, Yan H, Yu T, Sun H-P, Liu J-X, Li X-S, Wu W, Zhang F-Q, Chen Y, Zhou L, Li J-M, Zeng X-Y, Yang R-RO, Yuan M-M, Ren M-Y, Gu F-Y, Cao Q, Gu B-W, Su X-Y, Chen G-Q, Xiong S-M, Zhang T-D, Waxman S, Wang Z-Y, Chen Z, Hu J, Shen Z-X, Chen S-J: Studies on treatment of acute promyelocytic leukemia with arsenic trioxide: remission induction, follow-up and molecular monitoring in 11 newly-diagnosed and 47 relapsed acute promyelocytic leukemia patients. Blood. 1999, 94: 3315-3324.PubMed

Raffoux E, Rousselot P, Poupon J, Daniel M-T, Cassinat B, Delarue R, Taksin A-L, Rea D, Buzyn A, Tibi A, Lebbe G, Cimerman P, Chomienne C, Fermand J-P, Hugues T, Dengo L, Hermine O, Dombret H: Combined treatment with arsenic trioxide and all-trans-retinoic acid in patients with relapsed acute promyelocytic leukemia. J Clin Oncol. 2003, 21: 2326-2334. 10.1200/JCO.2003.01.149.CrossRefPubMed

Powell B, Moser B, Stock W, Gallager RE, Willman CL, Stone RM, Rowe JM, Coutre S, Feusner JH, Gregory J, Couban S, Appelbaum FR, Tallman MS, Larson RA: Arsenic trioxide improves event-free and overall survival for adults with acute promyelocytic leukemia: North American Leukemia Intergroup Study C9710. Blood. 2010, 116: 3751-3757. 10.1182/blood-2010-02-269621.CrossRefPubMedPubMedCentral

Shen Z-X, Chen G-Q, Ni J-H, Li X-S, Xiong S-M, Qui Q-Y, Zhu J, Tang W, Sun G-L, Yang K-Q, Chen Y, Zhou L, Fang Z-W, Wang Y-T, Ma J, Zhang P, Zhang T-D, Chen S-J, Chen Z, Wang Z-Y: Use of Arsenic Trioxide (As2O3) in the treatment of acute promyelocytic leukemia (APL): II. Clinical efficacy and pharmacokinetics in relapsed patients. Blood. 1997, 89: 3354-3360.PubMed

Yamamoto Y, Sasaki M, Oshimi K, Sugimoto K: Arsenic trioxide in a hemodialytic patient with acute promyelocytic leukemia. Acta Haematol. 2009, 122: 52-53. 10.1159/000243724.CrossRefPubMed

Au W-Y, Cheung GT, Yuen TW, Kumana CR, Kwong Y-L: Successful treatment of relapsed acute promyelocytic leukemia in a patient receiving continuous ambulatory peritoneal dialysis with oral arsenic trioxide. Arch Intern Med. 2005, 165: 1067-1068. 10.1001/archinte.165.9.1067.CrossRefPubMed

Douer D, Tallman M: Arsenic trioxide: New clinical experience with an old medication in hematologic malignancies. J Clin Oncol. 2005, 23: 2396-2410. 10.1200/JCO.2005.10.217.CrossRefPubMed

Jianhua N, Guoqiang C, Zhixiang S, Xiushong L, Haiwei L, Yanting H, Zhiwen F, Saijuan C, Zhenyi W, Zhu C: Pharmacokinetics of intravenous arsenic trioxide in the treatment of acute promyelocytic leukemia. Chin Med J. 1998, 111: 1107-1110.

10.

Smith SB, Wombolt DG, Venkatesan R: Results of hemodialysis & hemoperfusion in the treatment of acute arsenic ingestion. Clin Exper Dialysis Apharesis. 1981, 5: 399-404.CrossRef

11.

Lai MW, Boyer EW, Kleinman ME, Rodig NM, Ewald MB: Acute arsenic poisoning in two siblings. Pediatrics. 2005, 116: 249-257. 10.1542/peds.2004-1957.CrossRefPubMed

Title: Relapsed acute promyelocytic leukemia in a hemodialysis-dependent patient treated with arsenic trioxide: a case report
Authors: Gregory S Emmons
Richard H Steingart
James A Stewart
Wilson C Mertens
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Journal of Medical Case Reports / Issue 1/2012
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/1752-1947-6-355

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Relapsed acute promyelocytic leukemia in a hemodialysis-dependent patient treated with arsenic trioxide: a case report

Abstract

Introduction

Case presentation

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Case presentation

Conclusion

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