Arsenic trioxide-based therapy is suitable for patients with psoriasis-associated acute promyelocytic leukemia – A retrospective clinical study

Figures & data

Table 1 The two postremission treatment regimes

	Treatment regimen A			Treatment regimen B
Time		Intermission (weeks)	Course duration (weeks)		Intermission (weeks)	Course duration
First year	ATO	2	1	DA*	2–4	3 (days) + 7/4 (days)
		3	1	DA*	2–4	3 (days) + 7/4 (days)
		4	2 or 3	DA*	2–4	3 (days) + 7/4 (days)
		4	1	ATO	4	2 (weeks)
		5	1	—	—	—
		6	2 or 3	—	—	—
		6	—	—	—	—
Second year	ATO	—	1	ATO	8	2 (weeks)
		7	1	—	—	—
		8	2 or 3	—	—	—
		8	1	—	—	—
		8	—	—	—	—
Third year	ATO	—	2 or 3	ATO	12	2 (weeks)
		7	1	—	—	—
		6	1	—	—	—
		6	2 or 3	—	—	—
		6	1	—	—	—
Fourth year	ATO	7	1	—	—	—
		7	2 or 3	—	—	—
		7	1	—	—	—
		8	1	—	—	—

Abbreviation: ATO, arsenic trioxide; DA, daunorubicin or idarubicin + cytarabine.

*Daunorubicin at 45 mg/m² or idarubicin 12 mg/m² for the first 3 days and cytarabine 100 mg/m² for 7 days or 2000 mg/m² for 4 days (patients 11, 13, and 14).

Table 2 History of psoriasis and therapeutic effect of ATO on psoriasis in the 17 patients with psoriasis-associated APL

					After ATO induction
Case	Duration of psoriasis (years)	Family history of psoriasis	Psoriasis treatment	PASI score before ATO treatment	PASI score	Percent PASI reduction (%)	Changes in skin lesions during postremission treatment	Outcomes	Follow-up (months)
1	13	N	Bimolane + LM	12	1	92	Relieved	Occasional mild recurrence	110
2	6	N	Bimolane + LM	12	1	92	Relieved	Occasional mild recurrence	97
3	20	N	Bimolane + LM	18	—	—	—	—	—
4	10	N	TCM + LM	12	1	92	Relieved	MRIA	38
5	9	N	TCM + LM	1.5	0	100	Relieved	MRIA	36
6	4	N	TCM + LM	14.4	0.9	94	Relieved	MRIA	35.5
7	3	N	LM	0.7	0	100	Relieved	MRIA	35
8	10	N	No medication	1.2	1.2	0	No change	No change	33
9	27	N	TCM + LM	39.2	15.6	60	Relieved	Death	27
10	10	N	TCM + LM	0.8	4.3	−438	Aggravated	Reached the most severe level (PASI score 12.6)	26
11	0	Y	—	—	—	—	Initial onset, aggravated, then relieved	MRIA	24
12	3	N	TCM + LM	10.8	1.8	83	Relieved	MRIA	20
13	3	N	TCM + LM	23.4	7.8	67	Relieved	MRIA	17
14	13	N	LM	0	0	—	Aggravated followed by relieved	MRIA	13
15	2	N	TCM + LM	0	0	—	PASI score: 0	PASI score: 0	11
16	20	N	Bimolane + LM	8	—	—	—	—	—
17	7	Y	MTX + PUVA + TCM	5.5	1	82	Relieved	MRIA	7

Abbreviation: APL, acute promyelocytic leukemia; ATO, arsenic trioxide; Y, yes; N, no; TCM, traditional Chinese medicine; LM, local medication; PUVA, psoralen–UV-A; PASI, the psoriasis area and severity index score; MTX, methotrexate; MRIA, mild recurrence during the intermittent period of ATO treatment.

Table 3 The baseline clinical manifestations of APL and treatment outcomes of the 17 patients with psoriasis-associated APL

										After ATO induction
Case	Sex/age (years)	t(15;17)/PML-RARα	WBC (×10^9/l)	Platelets (×10^9/l)	HB (g/l)	Fibrinogen level* (g/l)	D-dimer level^† (mg/l)	Creatinine level	Duration of induction therapy (days)	WBC (×10^9/l)	Platelets (×10^9/l)	HB (g/l)	Treatment regimen	Treatment outcomes
1	M/58	ND/L	0.4	95	72	2.1	>0.55	Normal	39	0.8	183	71	A	HCR 1
2	M/32	ND/L	20	30	40	ND	ND	ND	42	2.3	203	92	A	HCR 1
3	M/51	ND/S	28	20	124	0.6	11.82	119 μmol/l	—	14.7	43	87	—	ED
4	F/27	ND/L	0.3	49	62	2.4	13.75	Normal	36	3.6	149	73	A	HCR 1
5	M/44	+/L	2.74	12	108	0.6	2.65	Normal	50	2.2	156	115	A	HCR 2
6	F/15	+/L	0.97	4	71	1.1	11.51	Normal	40	1.5	112	66	B	HCR 1
7	M/37	+/L	0.6	22	81	3.4	0.08	Normal	34	1.5	104	61	B	HCR 1
8	F/41	+/S	14.8	12	92	1	1.9	Normal	37	2.4	220	65	B	HCR 1
9	M/41	ND/L	0.62	38	61	4.4	2.14	Normal	40	2.2	156	83	B	Died in relapse 1
10	F/41	ND/L	6.35	18	64	0.6	5.62	Normal	33	0.73	307	76	B	HCR 1
11	F/25	+Other^‡/L	5.16	8	99	2.3	17.91	Normal	30	8.4	111	93	B	HCR 1
12	M/47	+Other^‡/L	0.94	19	128	2.5	29.58	Normal	37	1.0	110	64	A	HCR 1
13	F/45	+/L	2.35	20	52	3.1	>50	Normal	26	2.18	141	118	B	HCR 1
14	M/31	+Other^‡/L	9.06	22	62	0.9	15.77	Normal	35	2.23	119	86	B	HCR 1
15	F/35	+/S	1.14	25	77	0.5	6	Normal	28	0.98	166	87	B	HCR 1
16	M/38	ND/L	0.53	20	85	0.6	>50	Normal	—	11	17	56	—	ED
17	M/47	+/S	0.27	11	66	3.3	11.67	Normal	36	1.93	128	85	B	HCR 1

Abbreviation: APL, acute promyelocytic leukemia; M, male; F, female; PML-RARα, promyelocytic leukemia–retinoic acid receptor-α; L, long; S, short; WBC, white blood cell count; HB, hemoglobin; ND, not done; ED, early death; HCR, hematologic complete remission.

Reference ranges for fibrinogen: 1.8–3.5 g/l; reference ranges for D-dimer: 0–0.55 mg/l; reference values for serum creatinine: 69–104 μmol/l (man).

*The median fibrinogen level for patients (n = 16) is 1.6 g/l (range, 0.5–4.4 g/l).

^†The median D-dimer level for patients (n = 16) is 11.59 mg/l (range, 0.08 to >50 mg/l (upper detection limit)).

^‡+Other, t(15;17) and additional chromosomal abnormalities.

Figure 1 Kaplan–Meier product limit estimate of OS (n = 17) and EFS (n = 17).

Figure 2 Kaplan–Meier product limit estimate of OS (A) and EFS (B) between patients receiving treatment regimen A (n = 5) and treatment regimen B (n = 10).