title: Successful treatment with arsenic trioxide of a patient with ATRA-resistant relapse of acute promyelocytic leukemia.
abstract: 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.
authors.affiliation: University of Vienna, Department of Internal Medicine I, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Agis
authors.forename: A
authors.initials: A
authors.lastname: Weltermann
authors.forename: G
authors.initials: G
authors.lastname: Mitterbauer
authors.forename: R
authors.initials: R
authors.lastname: Thalhammer
authors.forename: M
authors.initials: M
authors.lastname: Edelhäuser
authors.forename: H L
authors.initials: HL
authors.lastname: Seewann
authors.forename: P
authors.initials: P
authors.lastname: Valent
authors.forename: K
authors.initials: K
authors.lastname: Lechner
authors.forename: C
authors.initials: C
authors.lastname: Fonatsch
authors.forename: K
authors.initials: K
authors.lastname: Geissler
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects / Q000627:therapeutic use*; D001853:Bone Marrow / Q000378:metabolism / Q000473:pathology; D002871:Chromosome Banding; D003114:Colony-Forming Units Assay; D019008:Drug Resistance, Neoplasm; D001068:Feeding and Eating Disorders / Q000139:chemically induced; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy*; D007958:Leukocyte Count / Q000187:drug effects; D008677:Metaphase / Q000187:drug effects; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000139:chemically induced / Q000503:physiopathology; D010087:Oxides / Q000009:adverse effects / Q000627:therapeutic use*; D010146:Pain / Q000139:chemically induced; D016133:Polymerase Chain Reaction; D012008:Recurrence; D014212:Tretinoin / Q000494:pharmacology*
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D014212:Tretinoin; D000077237:Arsenic Trioxide