Arsenic Trioxide for APML, new cases

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Regimen

Intravenous arsenic trioxide

Arsenic trioxide was administered by diluting 10 mg/10 ml vials in 500 ml of Dextrose saline for adults infusing it intravenously over 2 - 3 hours, once a day till complete haematological remission (CR) or a maximum of 60 days

Following a 4 week interval, for those in CR, it was administered for another 4 weeks as a consolidation course

Subsequently after a second 4 week interval, for those continuing to remain in CR, it was administered 10 days a month for 6 months

One or two doses of an anthracycline were administered at the clinicians discretion if patients developed a differentiation syndrome not resolving or continuing to worsen after administration of Dexamethasone, if there was leucocyte count >50 x 109/lt at presentation or rapidly progressive leucocytosis defined as a rise >30 x 109/lt in the first week or >50 x 109/lt in the second week in spite of administering Hydroxyurea as per the guidelines


References

Vikram Mathews et al, Single agent arsenic trioxide in the treatment of newly diagnosed acute promyelocytic leukemia: durable remissions with minimal toxicity, Christian Medical Centre, India Blood First Edition Paper, prepublished online December 13, 2005; DOI 10.1182/blood-2005-08-3532