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Title: Dose-adjusted arsenic trioxide for acute promyelocytic leukaemia in chronic renal failure.
Austin Authors: Firkin, Frank;Roncolato, Fernando;Ho, Wai Khoon 
Affiliation: Department of Medicine, St Vincent's Hospital, Melbourne University, Fitzroy, Victoria, Australia
Department of Haematology, St George Hospital, Kogarah, NSW, Australia
Department of Haematology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Oct-2015
Date: 2015-03-23
Publication information: European journal of haematology 2015; 95(4): 331-5
Abstract: To determine the potential for arsenic trioxide (ATO) to be safely and effectively incorporated into induction therapy of newly diagnosed acute promyelocytic leukaemia (APL) in patients with severe chronic renal failure (CRF) by reduction of the ATO dosage to compensate for reduced renal elimination of arsenic in CRF. Two of the four CRF patients with APL in the study were dialysis-dependent, and two had eGFRs of 18 and 19 mL/min/1.73 m(2) . ATO dosage schedules were adjusted to obtain comparable whole-blood arsenic levels to those in APL patients with normal renal function who achieved molecular remission (MR) while receiving 10 mg ATO daily for 28 d. Average ATO administered per day in CRF patients ranged from 36 to 50% of the ATO administered to APL patients with normal renal function. No clinically significant cardiac, hepatic or other toxicities were detected. RT-PCR-negative MR was achieved after one treatment course in two patients and after two courses in the others. Relapse-free survival is 155, 60, 43 and 5 months. The observations in this pilot study have demonstrated whole-blood arsenic levels can provide a guide to adjustments of ATO dosage schedules that permit safe and effective therapeutic outcomes in APL patients with severely compromised renal function.
DOI: 10.1111/ejh.12502
Journal: European journal of haematology
PubMed URL: 25600167
Type: Journal Article
Subjects: acute promyelocytic leukaemia
arsenic blood level monitoring
arsenic trioxide
chronic renal failure
dosage adjustment
Appears in Collections:Journal articles

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