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Loh Z, Ashby M, Van Veldhuizen E, Li W, Chee A, Aung W, Lavrukhina Y, Mason G, Pelly T, Nedumannil R, Kosciejew S, Mokoonlall M, Lim J, Calov G, Butler L, Hillebrand P, Beekman A, Rathnasekara GK, Raj S, Zhang C, Yao Y, Iland H, Grigg A. Arsenic-induced neurotoxicity in patients with acute promyelocytic leukaemia. Br J Haematol 2024; 204:1732-1739. [PMID: 38198799 DOI: 10.1111/bjh.19297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/24/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Abstract
Arsenic trioxide is an essential component of therapy for acute promyelocytic leukaemia (APL) and is currently dosed on actual body weight with no upper limit. Arsenic-induced neurotoxicity is a well-recognised complication; however, there is uncertainty about its relationship to arsenic dose and obesity. We conducted a large multicentre retrospective study of 487 patients with APL treated with arsenic-based therapy across 23 sites in Australia from 2008 to 2023. The primary outcome was incidence of neurotoxicity, and secondary outcomes included relationship of neurotoxicity to obesity and cumulative arsenic dose. Any-grade neurotoxicity occurred in 113 (23%) patients, predominantly peripheral neuropathy (91%). Most events were grade 1-2 severity (85%), with grade 3 events in 12% and grade 4-5 in 3%. The incidence of neurotoxicity increased with BMI (non-obese: 16%, obesity class I: 25%, obesity class II-III: 41%; p < 0.001). On univariable analysis, obesity class I (OR 1.81, p = 0.036), obesity class II-III (OR 3.93, p < 0.001), weight >100 kg (OR 2.72, p < 0.001), daily arsenic trioxide dose >15 mg (OR 5.05, p < 0.001) and cumulative induction dose >500 mg (OR 3.95, p < 0.001) were all significantly associated with neurotoxicity. Obesity class II-III and induction dose >500 mg remained significant on multivariable analysis. Our study highlights the strong association between BMI, arsenic trioxide dose and neurotoxicity. Pre-emptive dose reductions should be considered for obese patients receiving high doses of arsenic.
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Affiliation(s)
- Zoe Loh
- Department of Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia
| | - Michael Ashby
- Department of Clinical Haematology, Alfred Health, Melbourne, Victoria, Australia
| | - Ellie Van Veldhuizen
- Department of Clinical Haematology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Wenlong Li
- Department of Clinical Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Department of Clinical Haematology, Concord Hospital, Concord, New South Wales, Australia
| | - Ashlyn Chee
- Department of Clinical Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Winpa Aung
- Department of Clinical Haematology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Yelena Lavrukhina
- Department of Clinical Haematology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - George Mason
- Department of Clinical Haematology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Tenille Pelly
- Department of Clinical Haematology, Gold Coast Hospital, Southport, Queensland, Australia
| | - Rithin Nedumannil
- Department of Clinical Haematology, Peter Maccallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Clinical Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Serena Kosciejew
- Department of Clinical Haematology, Townsville University Hospital, Townsville, Queensland, Australia
| | - Mridula Mokoonlall
- Department of Clinical Haematology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Jonathan Lim
- Department of Clinical Haematology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Georgina Calov
- Department of Clinical Haematology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Llewyn Butler
- Department of Clinical Haematology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Paulina Hillebrand
- Department of Clinical Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Ashley Beekman
- Department of Clinical Haematology, Barwon Health, Geelong, Victoria, Australia
| | | | - Sonia Raj
- Department of Clinical Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Cathey Zhang
- Department of Clinical Haematology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Yao Yao
- Department of Clinical Haematology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Harry Iland
- Department of Clinical Haematology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia
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Jen WY, Sasaki K, Rausch CR, DiNardo CD, Kadia TM, Yilmaz M, Borthakur G, Alvarado Y, McCue D, McCue D, Kantarjian HM, Ravandi F. Acute kidney injury in acute promyelocytic leukemia: a possible adverse effect of high dose arsenic trioxide in obese patients. Leuk Lymphoma 2024; 65:378-382. [PMID: 38054837 DOI: 10.1080/10428194.2023.2290467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
Arsenic trioxide (ATO)-based regimens are standard in acute promyelocytic leukemia (APL). ATO-related nephrotoxicity has not been reported. We reviewed APL patients treated with ATO to identify cases of acute kidney injury (AKI). Clinically significant cases were characterized. Multivariate analysis was performed to identify predictors of idiopathic, clinically significant AKI. One hundred and eight patients were included. ATO dose was 0.15 mg/kg/day using actual body weight with no dose cap. Thirty-one (28.7%) AKI cases were identified, 10 (32.3%) clinically significant. Six were idiopathic; five required dialysis. The proportion with significant, idiopathic AKI was 15.8% in patients receiving >15mg ATO versus 0% in those receiving ≤15mg (p = 0.001). On multivariate analysis, only ATO dose was a significant predictor of clinically significant AKI (odds ratio of 1.91, 95%CI, 1.19-3.07, p = 0.007). High-dose ATO may be associated with significant nephrotoxicity. We recommend that ATO dose be capped at 15 mg to minimize toxicity for this curable disease.
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Affiliation(s)
- Wei-Ying Jen
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caitlin R Rausch
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Courtney D DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tapan M Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Musa Yilmaz
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yesid Alvarado
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David McCue
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah McCue
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop M Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Boldig K, Kiamos A, Matthews-Hew T, Omman R, Quan W. Acute Promyelocytic Leukemia Treatment Masking Hepatic Tuberculosis: A Management Dilemma. J Hematol 2023; 12:100-104. [PMID: 37187498 PMCID: PMC10181323 DOI: 10.14740/jh1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
Acute promyelocytic leukemia is a form of acute myeloid leukemia (AML) that is characterized by presence of a promyelocytic leukemia-retinoic acid receptor alpha fusion. In most patients, this fusion is detected on conventional karyotype as the t(15;17)(q24.1;q21.2) translocation, but some patients have cryptic translocations with a normal karyotype. Historically, AML is associated with a poor prognosis. Treatment with all-trans retinoic acid and arsenic trioxide assures long-term survival in the majority of patients. This treatment is generally well-tolerated but may cause hepatotoxicity. This is usually identified by transaminitis but resolves after temporary cessation of treatment. Our patient's hepatotoxicity did not resolve following all-trans retinoic acid and arsenic trioxide cessation which posed a diagnostic dilemma. This prompted exploration of other possible causes of hepatotoxicity. An eventual liver biopsy identified acid-fast bacilli, confirming a diagnosis of hepatic tuberculosis. A broad differential diagnosis is imperative when investigating abnormalities in liver function, especially in chemotherapy patients when treatment cessation may cause cancer progression.
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Affiliation(s)
- Kimberly Boldig
- Department of Internal Medicine, University of Florida College of Medicine: Jacksonville, Jacksonville, FL 32209, USA
- Corresponding Author: Kimberly Boldig, Department of Internal Medicine, University of Florida College of Medicine: Jacksonville, Jacksonville, FL 32209, USA.
| | - Amy Kiamos
- Department of Internal Medicine, University of Florida College of Medicine: Jacksonville, Jacksonville, FL 32209, USA
| | - Trevanne Matthews-Hew
- Department of Hematology and Oncology, Mayo Clinic Jacksonville, Jacksonville, FL 32224, USA
| | - Reeba Omman
- Department of Pathology, University of Florida College of Medicine: Jacksonville, Jacksonville, FL 32209, USA
| | - Walter Quan
- Department of Hematology and Oncology, University of Florida College of Medicine: Jacksonville, Jacksonville, FL 32209, USA
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Wagner K, Unger L, Salman MM, Kitchen P, Bill RM, Yool AJ. Signaling Mechanisms and Pharmacological Modulators Governing Diverse Aquaporin Functions in Human Health and Disease. Int J Mol Sci 2022; 23:ijms23031388. [PMID: 35163313 PMCID: PMC8836214 DOI: 10.3390/ijms23031388] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 02/07/2023] Open
Abstract
The aquaporins (AQPs) are a family of small integral membrane proteins that facilitate the bidirectional transport of water across biological membranes in response to osmotic pressure gradients as well as enable the transmembrane diffusion of small neutral solutes (such as urea, glycerol, and hydrogen peroxide) and ions. AQPs are expressed throughout the human body. Here, we review their key roles in fluid homeostasis, glandular secretions, signal transduction and sensation, barrier function, immunity and inflammation, cell migration, and angiogenesis. Evidence from a wide variety of studies now supports a view of the functions of AQPs being much more complex than simply mediating the passive flow of water across biological membranes. The discovery and development of small-molecule AQP inhibitors for research use and therapeutic development will lead to new insights into the basic biology of and novel treatments for the wide range of AQP-associated disorders.
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Affiliation(s)
- Kim Wagner
- School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Lucas Unger
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK; (L.U.); (P.K.)
| | - Mootaz M. Salman
- Department of Physiology Anatomy and Genetics, University of Oxford, Oxford OX1 3QX, UK;
- Oxford Parkinson’s Disease Centre, University of Oxford, South Parks Road, Oxford OX1 3QX, UK
| | - Philip Kitchen
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK; (L.U.); (P.K.)
| | - Roslyn M. Bill
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK; (L.U.); (P.K.)
- Correspondence: (R.M.B.); (A.J.Y.); Tel.: +44-121-204-4274 (R.M.B.); +61-8-8313-3359 (A.J.Y.)
| | - Andrea J. Yool
- School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia;
- Correspondence: (R.M.B.); (A.J.Y.); Tel.: +44-121-204-4274 (R.M.B.); +61-8-8313-3359 (A.J.Y.)
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