Successful treatment with arsenic trioxide of a patient with ATRA-resistant relapse of acute promyelocytic leukemia

Ann Hematol. 1999 Jul;78(7):329-32. doi: 10.1007/s002770050523.


Arsenic trioxide has recently been introduced as a promising new agent to treat refractory acute promyelocytic leukemia (APL). In the present study, arsenic trioxide was given intravenously for 42 days to a 56-year-old female patient suffering from chemotherapy/ATRA-resistant APL, with 43% APL blasts in the bone marrow and elevated D-dimers. During the first days of arsenic trioxide treatment a rapid decrease in the D-dimers was seen (normal values reached until day 7), together with a slight decrease in peripheral blood leukocytes. This initial coagulation response was followed by a second phase of hematological response (starting on days 15-20) characterized by leukocytosis, occurrence of myeloid progenitor cells in the peripheral blood, and a decrease in bone marrow blasts (<1% on days 28 and 36). Finally, the patient entered complete hematological and cytogenetic remission, although the PML-RAR alpha fusion product was still detectable by PCR. These data confirm the therapeutic value of arsenic trioxide in relapsed/resistant APL.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use*
  • Arsenic Trioxide
  • Arsenicals / adverse effects
  • Arsenicals / therapeutic use*
  • Bone Marrow / metabolism
  • Bone Marrow / pathology
  • Chromosome Banding
  • Colony-Forming Units Assay
  • Drug Resistance, Neoplasm
  • Feeding and Eating Disorders / chemically induced
  • Female
  • Humans
  • Leukemia, Promyelocytic, Acute / drug therapy*
  • Leukocyte Count / drug effects
  • Metaphase / drug effects
  • Middle Aged
  • Musculoskeletal Diseases / chemically induced
  • Musculoskeletal Diseases / physiopathology
  • Oxides / adverse effects
  • Oxides / therapeutic use*
  • Pain / chemically induced
  • Polymerase Chain Reaction
  • Recurrence
  • Tretinoin / pharmacology*


  • Antineoplastic Agents
  • Arsenicals
  • Oxides
  • Tretinoin
  • Arsenic Trioxide