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Shim KG, Crain M, Augustin K, Oetjen KA. Management of acute promyelocytic leukemia in the setting of acute COVID-19 infection. Leuk Res Rep 2022; 18:100353. [PMID: 36275842 PMCID: PMC9579833 DOI: 10.1016/j.lrr.2022.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 09/13/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Acute promyelocytic leukemia (APL) often presents with significant coagulopathy which may result in both hemorrhagic and thrombotic complications. The emergence of the COVID-19 pandemic has complicated the initial treatment and diagnosis of APL owing to the viral infection's own associated coagulopathy. Here we report two cases of APL newly diagnosed in the setting of COVID-19 infection and considerations in their management. Included is a discussion of strategies for the dosing of arsenic trioxide in patients with significant obesity and renal insufficiency. The case series submitted does not represent a study on patients and thus no specific informed consents or permissions were required. All images included in our manuscript have been deidentified and all authors certify that personal details that could potentially be used to identify the patients in the cases described have been removed. The corresponding author has personally confirmed that both patients included in this study have given verbal permission to present their cases in the de-identified manner as described above.
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Affiliation(s)
- Kevin G Shim
- Department of Internal Medicine, Division of Hospital Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, 21287, MD, United States
- Corresponding author at: Department of Internal Medicine, Johns Hopkins University, 600 N. Wolfe St., Baltimore, MD 21287, United States
| | - Mallory Crain
- Department of Pharmacy, Barnes Jewish Hospital, Mail Stop 90-52-411, 1 Barnes-Jewish Hospital Plaza, Saint Louis, 63110, MO, United States
| | - Kristan Augustin
- Department of Pharmacy, Barnes Jewish Hospital, Mail Stop 90-52-411, 1 Barnes-Jewish Hospital Plaza, Saint Louis, 63110, MO, United States
| | - Karolyn A Oetjen
- Department of Internal Medicine, Division of Oncology, Washington University, Mail Stop 8007-0057-07 660 S Euclid Ave., Saint Louis, 63110, MO, United States
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Tinajero J, El-Shami K, Wu X, Smith BD, Newman MJ. Arsenic trioxide for acute promyelocytic leukemia in a patient on chronic hemodialysis. Leuk Res Rep 2022; 17:100304. [PMID: 35371914 PMCID: PMC8968060 DOI: 10.1016/j.lrr.2022.100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 01/10/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is a rare acute leukemia generally considered curable with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). Some patients have co-morbidities that may limit the use of these agents and therefore impact curability. Adverse effects of ATO include life-threatening electrocardiographic abnormalities. ATO and its metabolites are partially excreted in the urine, and it is unclear to what extent ATO pharmacokinetics are impacted by hemodialysis. We present a patient on chronic hemodialysis successfully treated with ATO and ATRA for newly diagnosed APL. Complete molecular remission was achieved after induction and several drug-related toxicities were managed.
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Lee HJ, Park SG. Successful treatment of relapsed acute promyelocytic leukemia with arsenic trioxide in a hemodialysis-dependent patient: A case report. World J Clin Cases 2020; 8:5347-5352. [PMID: 33269269 PMCID: PMC7674717 DOI: 10.12998/wjcc.v8.i21.5347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/06/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Arsenic trioxide (ATO) is recommended for patients who do not achieve molecular remission or who have molecular or morphologic relapse. However, there are no guidelines for adjusting ATO dosage in patients with severe renal failure or on dialysis. Herein, we report the successful treatment of relapsed acute promyelocytic leukemia (APL) in a patient on hemodialysis with ATO single agent and review the cases in literature.
CASE SUMMARY A 46-year-old woman who has been on hemodialysis to chronic glomerulone-phritis for 15 years visited our hospital for pancytopenia. She had been seen for pancytopenia 3 years ago and had been diagnosed with APL. She also received chemotherapy for APL but unfortunately was lost to follow-up after her second consolidation chemotherapy. She was noted to have pancytopenia by her nephrologist during hemodialysis 1 mo ago. Bone marrow biopsy and reverse transcriptase-polymerase chain reaction (RT-PCR) tests revealed a diagnosis of relapsed APL. Treatment for relapsed APL with ATO single agent was started and she achieved molecular remission after administering 24 doses of ATO. Thus far, four consolidation therapies have been performed with the ATO single agent, and, to date, the molecular remission has been maintained as negative promyelocytic leukemia/retinoic acid receptor-α fusion gene as confirmed by RT-PCR testing for two years.
CONCLUSION This is a rare case of relapsed APL successfully treated with the single agent ATO in a patient on hemodialysis.
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Affiliation(s)
- Hee Jeong Lee
- Department of Hemato-Oncology, Chosun University Hospital, Gwang-ju 501-717, South Korea
| | - Sang-Gon Park
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 61453, South Korea
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Gao C, Fan S, Hostetter TH, Wang W, Li J, Guo M, Zhou J, Hai X. Effect of continuous venovenous haemodialysis on outcome and pharmacokinetics of arsenic species in a patient with acute promyelocytic leukaemia and acute kidney injury. Br J Clin Pharmacol 2019; 85:849-853. [PMID: 30677159 DOI: 10.1111/bcp.13875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/27/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022] Open
Abstract
This study presents outcome and pharmacokinetics of arsenic trioxide (ATO) metabolites in patients on continuous venovenous haemodialysis (CVVHD). Of 3 acute promyelocytic leukaemia patients receiving CVVHD in management of acute kidney injury, only 1 patient was included. The patient presented disseminated intravascular coagulation and acute kidney injury before induction therapy was conducted. CVVHD was performed and ATO was initiated. Species of ATO metabolites in plasma and effluent were analysed using high performance liquid chromatography-hydride generation-atomic fluorescence spectrometry. Plasma concentrations of AsIII , monomethylarsonic acid and dimethylarsinic acid with CVVHD were lower than those without CVVHD. Area under the concentration-time curve from 0 to the last sample with quantifiable concentration of AsIII without CVVHD was significantly higher than that with CVVHD (292.10 ng h/mL vs 195.86 ng h/mL, P = .037), which were not observed for monomethylarsonic acid and dimethylarsinic acid. Dialysate saturation of arsenic species was remarkable, especially for AsIII . Complete remission was achieved and renal function recovered. In this study, ATO can be used safely and effectively to treat acute promyelocytic leukaemia patients undergoing CVVHD without dose adjustment.
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Affiliation(s)
- Chunlu Gao
- Department of Pharmacy, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Shengjin Fan
- Department of Hematology, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Thomas H Hostetter
- Department of Medicine, Case Western University School of Medicine, Cleveland, OH, USA
| | - Wenjing Wang
- Department of Pharmacy, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Jing Li
- Department of Pharmacy, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Meihua Guo
- Department of Pharmacy, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Jin Zhou
- Department of Hematology, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Xin Hai
- Department of Pharmacy, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
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Management of patients with acute promyelocytic leukemia. Leukemia 2018; 32:1277-1294. [DOI: 10.1038/s41375-018-0139-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/08/2018] [Accepted: 04/11/2018] [Indexed: 01/10/2023]
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