Successful treatment of relapsed acute promyelocytic leukemia with arsenic trioxide in a hemodialysis-dependent patient: A case report

Table 1 Arsenic trioxide treatment in acute promyelocytic leukemia patients with severe renal impairment or on hemodialysis

Patient	Age/sex	Diagnosis	Dialysis type/ATO measure	ATO dose schedule adjustment	Duration of course	Total ATO dose prior to MR or CR	Outcome
1[14]	65/F	Relapsed APL, DM, IHD	CAPD, Plasma arsenic level	Induction, oral ATO 5 mg/d, consolidation × 6, oral ATO 5 mg/d for 14 d q2 mo	23 d, 14 d every two months	23 doses	Died d/t diabetic leg gangrene on 24 mo after CR, MR maintained for 4 mo after CR
2[15]	42/M	Relapsed APL, Septicemia	HD-> CAPD, plasma arsenic level	Induction 1st day, ATRA 45 mg/m2/d + oral ATO 10mg/d 2nd day, oral ATO 5 mg/d d/t AKIm 3rd day, ATRA stop d/t APL differentiation syndrome. Idarubicin 6 mg/m2/d × 5 d, dexamethasone 12 mg/d × 7 d, alternate daily HD was started and oral ATO 5 mg after HD for 9 d. Consolidation, oral ATO 2 mg/d after HD, maintenance: CAPD was started, oral ATO 5 mg/d + ATRA 20 mg twice daily for 2 wk every 2 mo	28 d, 48 d	7 doses	Alive, achieved CR at 4 wk, At 6-mo follow-up, no recurrence
3[16]	73/M	De novo APL	HD, plasma arsenic level	Induction, ATRA 70 mg/d + Ara-C 240 mg/m2 × 5 d + daunorubicin 30 mg/m2 × 3 d, induction failure and ARF, reinduction ATO 0.15 mg/kg/d, 2 or 3 times a week	23 d, 3 mo	36 doses	No record
4[17]	81/M	Relapsed APL, DM, HTN, PCI d/t CAD	HD, whole blood arsenic level	Induction, fixed dose 10 mg twice weekly, not achieved CR, fixed dose 10 mg three times weekly, consolidation × 2, 10 mg IV three times weekly	8 wk (13 doses), 12 wk, 25 doses every consolidation	47 doses	Died d/t hemorrhagic stroke at two months after second consolidation
5[18]	33/M	Relapsed APL, AIDS, CKD d/t FSG, congenital solitary kidney	HD, not measured	Induction, ATO 0.1 mg/kg four times weekly for 60 d: Not achieved CR, ATO 0.15 mg/kg EOD for 60 d, consolidation × 2, idarubicin 12 mg/m2 × 2 d q4 wk, maintenance ATO 0.1 mg/kg 3 times weekly-> two times weekly after nine doses	120 d, 27 doses	CR is not achieved after first 60 d. But CR achieved after additional 60 d (total dose administered was not record)	Alive
6[19]	23/M	De novo APL	CRRT-> HD, not measured	Induction, ATRA 25 mg/m2 + idarubicin 10 mg/d × 3 d, 3rd day; CRRT and intubation was performed ATO 0.15 mg/kg/d, at 17 d after the start ATO; weaned off the ventilator and converted CRRT to HD, consolidation × 5, ATO 10 mg/d for 10 d per 30 or 45 d	Not record	Total dose administered was not record	Alive. At 3 mo after the initiation of treatment achieved CR. At 7 mo after achievement CR, performed KT, up to 1 year after KT, no recurrence
7[20]	29/F	De novo APL	CAPD, whole blood arsenic level	Only induction, ATO 10 mg for 10 d + ATRA 45 mg/m2	10 d	10 doses	Relapse free survival is 155 mo
8[20]	65/M	De novo APL, DM	HD, whole blood arsenic level	Only induction, ATO 10 mg three times weekly after HD	27 d	11 doses	Relapse free survival is 43 mo

ATO: Arsenic trioxide; MR: Molecular remission; CR: Complete remission; APL: Acute promyelocytic leukemia; DM: Diabetes mellitus; IHD: Ischemic heart disease; CAPD: Continuous ambulatory peritoneal dialysis; HD: Hemodialysis; ATRA: All-trans retinoic acid; ARF: Acute renal failure; AKI: Acute kidney insufficiency; HTN: Hypertension; PCI: Percutaneous coronary intervention; CAD: Coronary artery disease; AIDS: Acquired immune deficiency syndrome; CKD: Chronic kidney disease; FSG: Focal segmental glomerulosclerosis; EOD: Every other day; CRRT: Continuous renal replacement therapy; KT: Kidney transplantation.