Bone marrow necrosis in a patient with acute promyelocytic leukemia during re-induction therapy with arsenic trioxide |
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Authors: | Ishitsuka Kenji Shirahashi Akihiko Iwao Yasuhiro Shishime Mikiko Takamatsu Yasushi Takatsuka Yoshifusa Utsunomiya Atae Suzumiya Junji Hara Syuji Tamura Kazuo |
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Affiliation: | 1st Department of Internal Medicine, Fukuoka University, Fukuoka, Japan. |
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Abstract: | 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 x 10(3)/microl increased to 134 x 10(3)/microl 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 x 10(3)/microl. 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 microm 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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Keywords: | acute promyelocytic leukemia arsenic trioxide bone marrow necrosis |
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