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J Oncol Pharm Pract. 2016 Aug;22(4):646-51. doi: 10.1177/1078155215586235. Epub 2015 May 12.

Use of arsenic trioxide in a hemodialysis-dependent patient with relapsed acute promyelocytic leukemia.

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Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA.
University of Connecticut, School of Pharmacy, Storrs, CT, USA.
Department of Cardiovascular and Metabolism, Novartis Institutes for BioMedical Research, Inc., Cambridge, MA, USA.
Department of Internal Medicine, Hematology Section, Yale University School of Medicine, New Haven, CT, USA.


Arsenic trioxide has been established for use in both relapsed and front-line treatment of acute promyelocytic leukemia. Dose adjustments are recommended to be considered in severe renal impairment although dosage reduction guidelines are not provided. In addition, toxicities of arsenic are significant. The use of arsenic trioxide has not been well studied in dialysis patients and there is a paucity of data in the literature to support the use in such a situation. We describe an 81-year-old relapsed acute promyelocytic leukemia hemodialysis-dependent patient with a pre-existing cardiac condition who was treated with 10 mg arsenic trioxide three times weekly after dialysis. These findings provide support along with the marginal amount of currently published data for an arsenic trioxide dosing regimen in hemodialysis patients.


Arsenic trioxide; acute promyelocytic leukemia; hemodialysis

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