The Role of Arsenic Treatment after Induction in Alternative and Long-Term Cases for the Prevention of Acute Promyelocytic Leukemia Recurrence

Abstract

Introduction: Arsenic has been used as an effective medicine in the treatment of severe promyelocytic leukemia in recurrence and resistance cases toward ATRA. In this study, it has been used as induction and maintenance therapy after remission.
Method & Material: We studied 31 patients diagnosed by APL. Arsenic was started at a dose of 0.15 mg/kg (daily) until patient’s bone marrow remission.(1) We started Arsenic as a consolidation therapy after 28 days rest and then we continued the treatment with Arsenic each 3-4 months during 2 years for 14 days.
Results: 4 patients died (12.9%) during the first 15 days of treatment. 27 patients (87%) went into remission. 2 patients refused the continuation of treatment regardless the remission. 25 patients received a long term treatment. The disease of 3 out of 25 patients recurred during follow -up period. 1 patient died during the treatment after recurrence and 3 others given ATRA & Arsenic went into remission. Now, It has been past 2 months since the end of their remission. The recurrence appeared in the form of full involvement of thoraco-lumbar which was observed as an extensive tumor on MRI and was found to cover the mentioned area. 1 patient faced CNS fungal infection during neutropenia period and then recovered after operation and proper treatment; however his vision was severely damaged. As 4 patients faced leukocytosis over 1000/000ml, we were obliged to discontinue arsenic for 3-4 days and chemotherapy by Danurobicine was prescribed for 2 days. The patient’s follow-up and the median survival time were 54 and 48 months, respectively. The overall survival was 80.6%.
Discussion: Arsenic as the first line therapy for APL is an effective treatment .Consistent long- term therapy with intervals will reduce the risk of disease recurrence.