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

• Published in: International journal of hematology Vol. 83; no. 4; pp. 318 - 323
• Main Authors: NAITO, Kensuke, KOBAYASHI, Miki, SAHARA, Naohi, SHIGENO, Kazuyuki, NAKAMURA, Satoki, SHINJO, Kaori, TOBITA, Tadasu, TAKESHITA, Akihiro, OHNO, Ryuzo, OHNISHI, Kazunori
• Format: Journal Article
• Language: English
• Published: Tokyo Springer 01.05.2006; Springer Nature B.V
• Subjects: Adult; Anthracyclines - administration & dosage; Anthracyclines - adverse effects; Antifungal Agents - administration & dosage; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Arsenicals - administration & dosage; Arsenicals - adverse effects; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiomyopathies - chemically induced; Cardiomyopathies - complications; Female; Fluconazole - administration & dosage; Heart; Hematologic and hematopoietic diseases; Humans; Hypokalemia - chemically induced; Hypokalemia - complications; Leukemia, Promyelocytic, Acute - complications; Leukemia, Promyelocytic, Acute - drug therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Medical sciences; Middle Aged; Oxides - administration & dosage; Oxides - adverse effects; Time Factors; Torsades de Pointes - chemically induced; Torsades de Pointes - drug therapy; Promyelocytic leukemia; Wave burst; Arrhythmia; Hematology; Acute; Cardiovascular disease; Arsenic trioxide; Malignant hemopathy; Excitability disorder; Treatment; Acute promyelocytic leukemia; Heart disease; Complication; Arsenic trioxide therapy; Torsade de pointes; M3 acute myelocytic leukemia
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1532/ijh97.05056

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.