Bone marrow necrosis in a patient with acute promyelocytic leukemia during re-induction therapy with arsenic trioxide
Kenji Ishitsuka
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorAkihiko Shirahashi
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorYasuhiro Iwao
Medicinal Informatics and Research Units, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
Search for more papers by this authorMikiko Shishime
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorYasushi Takamatsu
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorYoshifusa Takatsuka
Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan
Search for more papers by this authorAtae Utsunomiya
Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan
Search for more papers by this authorJunji Suzumiya
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorSyuji Hara
Medicinal Informatics and Research Units, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
Search for more papers by this authorKazuo Tamura
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorKenji Ishitsuka
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorAkihiko Shirahashi
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorYasuhiro Iwao
Medicinal Informatics and Research Units, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
Search for more papers by this authorMikiko Shishime
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorYasushi Takamatsu
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorYoshifusa Takatsuka
Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan
Search for more papers by this authorAtae Utsunomiya
Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan
Search for more papers by this authorJunji Suzumiya
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorSyuji Hara
Medicinal Informatics and Research Units, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
Search for more papers by this authorKazuo Tamura
1st Department of Internal Medicine, Fukuoka University
Search for more papers by this authorAbstract:
Arsenic trioxide (As2O3) therapy at a daily dose of 0.15 mg/kg was given to a 60-yr-old Japanese male with refractory acute promyelocytic leukemia. White blood cell (WBC) of 6.6 × 103/μl increased to 134 × 103/μl following the administration of As2O3. Daily hydroxyurea (HU), and 6-mercaptopurine (6-MP) were added on days 7 and 19, respectively. Both HU and 6-MP were discontinued on day 28, when WBC declined to 54.0 × 103/μl. He developed unexplained fever and profound cytopenia requiring multiple blood products transfusions. Bone marrow examination on day 42 revealed massive necrosis. Pharmacokinetics confirmed a mean maximum plasma arsenic concentration (Cpmax) and a half-life time (t1/2) of 6.9 μm and 3.2 h, respectively, in the therapeutic range. This is the first case of bone marrow necrosis after standard-dose As2O3 therapy.
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