Bone Marrow Necrosis in a Patient With Acute Promyelocytic Leukemia During Re-Induction Therapy With Arsenic Trioxide

Eur J Haematol. 2004 Apr;72(4):280-4. doi: 10.1111/j.0902-4441.2003.00206.x.

Abstract

Arsenic trioxide (As2O3) therapy at a daily dose of 0.15 mg/kg was given to a 60-yr-old Japanese male with refractory acute promyelocytic leukemia. White blood cell (WBC) of 6.6 x 10(3)/microl increased to 134 x 10(3)/microl following the administration of As2O3. Daily hydroxyurea (HU), and 6-mercaptopurine (6-MP) were added on days 7 and 19, respectively. Both HU and 6-MP were discontinued on day 28, when WBC declined to 54.0 x 10(3)/microl. He developed unexplained fever and profound cytopenia requiring multiple blood products transfusions. Bone marrow examination on day 42 revealed massive necrosis. Pharmacokinetics confirmed a mean maximum plasma arsenic concentration (Cpmax) and a half-life time (t1/2) of 6.9 microm and 3.2 h, respectively, in the therapeutic range. This is the first case of bone marrow necrosis after standard-dose As2O3 therapy.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Arsenic Trioxide
  • Arsenicals / administration & dosage
  • Arsenicals / adverse effects*
  • Bone Marrow / pathology*
  • Bone Marrow Diseases / chemically induced*
  • Fever / chemically induced
  • Humans
  • Hydroxyurea / administration & dosage
  • Hydroxyurea / adverse effects
  • Leukemia, Promyelocytic, Acute / drug therapy*
  • Male
  • Mercaptopurine / administration & dosage
  • Mercaptopurine / adverse effects
  • Middle Aged
  • Necrosis
  • Oxides / administration & dosage
  • Oxides / adverse effects*
  • Pancytopenia / chemically induced
  • Remission Induction

Substances

  • Arsenicals
  • Oxides
  • Mercaptopurine
  • Arsenic Trioxide
  • Hydroxyurea