Two cases of acute promyelocytic leukemia complicated by torsade de pointes during arsenic trioxide therapy.
We describe 2 patients with acute promyelocytic leukemia (APL) in whom torsade de pointes (TdP) developed during treatment with arsenic trioxide. Patient 1 was a 23-year-old woman with second-relapse APL. Ventricular premature beat bigeminy developed on day 27 of treatment, and episodes of TdP developed on day 28. Patient 2 was a 51-year-old woman with second-relapse APL who had cardiomyopathy due to prior anthracycline treatment. TdP developed on day 17 of treatment. Arsenic trioxide is known to cause electrocardiographic abnormalities, such as ventricular tachycardia and prolongation of QT interval. Patient 1 was given fluconazole as a concomitant drug. Patient 2 had cardiomyopathy and hypokalemia. Careful management is needed during arsenic trioxide therapy because this treatment prolongs the QT interval, possibly inducing episodes of TdP.
Naito
Kensuke
K
Division of Hematology, Department of Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan. kensuke.naito@nifty.com
Kobayashi
Miki
M
Sahara
Naohi
N
Shigeno
Kazuyuki
K
Nakamura
Satoki
S
Shinjo
Kaori
K
Tobita
Tadasu
T
Takeshita
Akihiro
A
Ohno
Ryuzo
R
Ohnishi
Kazunori
K
D000328:Adult; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects; D000935:Antifungal Agents / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000008:administration & dosage / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000139:chemically induced / Q000150:complications; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced / Q000150:complications; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D010087:Oxides / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000188:drug therapy
D018943:Anthracyclines; D000935:Antifungal Agents; D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D015725:Fluconazole; D000077237:Arsenic Trioxide