The Complication And Arsenic Trioxide Syndrome During The Treatment Of Acute Promyelocytic Leukemia

Objective: To study the complication and the side-effect related to arsenic trioxide(AS2O3) treatment during the remission induction in patients with newly diagnosed acute promyelocytic leukemia (APL) and the impact of the initial white blood cell (WBC)counts on the prognosis of APL.Methods: The clinical information of 62 patients with newly diagnosed APL was retrospectively analyzed. The patients were treated with all-trans retinoic acid(ATRA)40～80mg/d until complete remission (CR)or AS2O310mg/d for 28 days as a course of treatment。The doses were adjusted according to WBC counts,occurrence of RA syndrome(RAS)and the status of liver function.CR rate,time of reaching CR and side effects were observed.Result: 18.2% patients occurred disseminated intravascular coagulation(DIC)during the remission induction; 67.6%,57.1% patients occurred leukocytosis and 13.5%,3.6% patients occurred intracranial hemorrhage respectively during the treatment with AS2O3 and ATRA.. 18.9% of patients treated with AS2O3 occurred arsenic trioxide syndrome which was similar to RAS. WBC counts of 40 patients were less than 10×109/L when they were newly diagnosed. CR rate of them was 72.5%,which was higher evidently than one(45.5%) of patients whose WBC counts were more than 10×109/L(P<0.05) .Conclusion: The incidence of DIC during the treatment of APL decreases. AS2O3 can result in arsenic trioxide syndrome and leukocytosis. A WBC of≥10×109/L is an adverse prognostic feature.WBC≥10×109/L can be considered"hyperleukocytosis".