Two cases of acute promyelocytic leukemia complicated by torsade de pointes during arsenic trioxide therapy.

Abstract

We describe 2 patients with acute promyelocytic leukemia (APL) in whom torsade de pointes (TdP) developed during treatment with arsenic trioxide. Patient 1 was a 23-year-old woman with second-relapse APL. Ventricular premature beat bigeminy developed on day 27 of treatment, and episodes of TdP developed on day 28. Patient 2 was a 51-year-old woman with second-relapse APL who had cardiomyopathy due to prior anthracycline treatment. TdP developed on day 17 of treatment. Arsenic trioxide is known to cause electrocardiographic abnormalities, such as ventricular tachycardia and prolongation of QT interval. Patient 1 was given fluconazole as a concomitant drug. Patient 2 had cardiomyopathy and hypokalemia. Careful management is needed during arsenic trioxide therapy because this treatment prolongs the QT interval, possibly inducing episodes of TdP.

• Authors: Kensuke Naito, Miki Kobayashi, Naohi Sahara, Kazuyuki Shigeno, Satoki Nakamura, Kaori Shinjo, Tadasu Tobita, Akihiro Takeshita, Ryuzo Ohno, Kazunori Ohnishi
• Journal: International journal of hematology (Int J Hematol) Vol. 83 Issue 4 Pg. 318-23 (May 2006) ISSN: 0925-5710 [Print] Japan
• PMID: 16757431 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anthracyclines
• Antifungal Agents
• Antineoplastic Agents
• Arsenicals
• Oxides
• Fluconazole
• Arsenic Trioxide

Topics

• Adult
• Anthracyclines (administration & dosage, adverse effects)
• Antifungal Agents (administration & dosage)
• Antineoplastic Agents (administration & dosage, adverse effects)
• Arsenic Trioxide
• Arsenicals (administration & dosage, adverse effects)
• Cardiomyopathies (chemically induced, complications)
• Female
• Fluconazole (administration & dosage)
• Humans
• Hypokalemia (chemically induced, complications)
• Leukemia, Promyelocytic, Acute (complications, drug therapy)
• Middle Aged
• Oxides (administration & dosage, adverse effects)
• Time Factors
• Torsades de Pointes (chemically induced, drug therapy)