Arsenic in the cerebrospinal fluid of a patient receiving arsenic trioxide for relapsed acute promyelocytic leukemia with CNS involvement.
We report on a 42-year-old patient whose relapse of acute promyelocytic leukaemia (APL) included meningeal infiltration. Since he had previously experienced ATRA syndrome, he received arsenic trioxide (ATO) plus intrathecal therapy with cytarabine, prednisone, and methotrexate. We measured the concentration of arsenic in his cerebrospinal fluid (CSF). Arsenic showed a peak CSF concentration of 0.008 mg/l (0.11 micromol/l) and a nadir of 0.002 mg/l (0.027 micromol/l), both representing about 14% of blood levels. ATO thus crosses the blood-CSF-barrier when administered intravenously, but the concentration in CSF is probably not sufficient for treatment of meningeal leukemia.
Knipp
Sabine
S
Department of Haematology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 44, 1011, Lausanne, Switzerland. sabine.knipp@chuv.ch
Gattermann
Norbert
N
Schapira
Marc
M
Käferstein
Herbert
H
Germing
Ulrich
U
D000328:Adult; D000970:Antineoplastic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001151:Arsenic / Q000134:cerebrospinal fluid*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000235:genetics; D008297:Male; D010087:Oxides / Q000493:pharmacokinetics / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D001151:Arsenic; D000077237:Arsenic Trioxide