Successful Treatment of All-Trans Retinoic Acid Resistant and Chemotherapy Naive Acute Promyelocytic Patients with Arsenic Trioxid-e - Two Case Reports

Abstract

Arsenic trioxide(As₂O₃) has proved highly effective in treating both refractory or primary cases of acute promyelocytic leukemia (APL). The role of arsenic trioxide in APL treatment has been confirmed by study groups in China and in the USA. However, what is the role of As₂O₃ in treating APL? Should it be used as first line therapy, or should it be used as a second line drug. This still remains to be defined.

Here, we report two cases of APL, who were treated successfully with As₂O₃ when they relapsed. Initially, both received all-trans retinoic acid (ATRA) for primary remission induction therapy, and obtained a complete remission. For ethical or personal reasons, they did not receive chemotherapy as consolidation therapy and when they relapsed at 23 months and 12 months later respectively, they both received As₂O3 therapy after being resistant to ATRA treatment. Two courses of As₂O₃ were given and both reached complete remission. There were very few adverse reactions to the drug, only mild abdominal cramps, mild fluid retention, and transient elevation of transarninases. They both had rather good quality of life throughout the treatment and both remain in remission for 32 months and 10 months since therapy, respectively.

Key Words:

• acute promyelocytic leukemia
• As₂O₃
• ATRA resistant