What is it about?
Arsenic trioxide revolutionised treatment of acute promyelocytic leukaemia, but used to be withheld from patients with impaired renal function. We found reducing the dose to produce similar blood levels to normal renal function patients was equally effective and not associated with increased toxicity
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Why is it important?
Arsenic trioxide is particularly effective in treating what formerly was the most rapidly fatal form of acute myeloid leukaemia, and in combination with all trans retinoic acid is curative in most cases. Dose adjustment can now permit it to be used in the significant minority of previously excluded patients with renal impairment as appropriate dose reduction results fully effective outcomes that are not associated with increased toxicity.
Perspectives
Arsenic trioxide is understandably a cause for concern because of its reputation as a poison, but this particular form of leukaemia is extraordinarily susceptible to a lethal outcome at much lower levels of arsenic than normal human tissues to account for its very high therapeutic ratio in this disorder.
Frank Firkin
University of Melbourne
Read the Original
This page is a summary of: Dose-adjusted arsenic trioxide for acute promyelocytic leukaemia in chronic renal failure, European Journal Of Haematology, March 2015, Wiley,
DOI: 10.1111/ejh.12502.
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