Arsenic trioxide dose capping to decrease toxicity in the treatment of acute promyelocytic leukemia

Kyle Zacholski, Bryan Hambley, Erin Hickey, Sarah Kashanian, Andrew Li, Maria R. Baer, Vu H. Duong, Matthew J. Newman, Amy DeZern, Ivana Gojo, B. Douglas Smith, Mark J. Levis, Ravi Varadhan, Eric Gehrie, Ashkan Emadi, Gabriel Ghiaur

Research output: Contribution to journalArticlepeer-review


Arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) combination therapy yields high complete remission and disease-free survival rates in acute promyelocytic leukemia (APL). ATO is dosed on actual body weight and high ATO doses in overweight patients may contribute to increased toxicity. We performed a retrospective, two-center study comparing toxicities in patients who received the Lo-Coco et al ATRA/ATO regimen with capped ATO, ≤10 mg/dose, and non-capped ATO, >10 mg/dose. A total of 44 patients were included; 15 received doses ≤10 mg and 29 received >10 mg. During induction, there was no difference in the incidence of grade ≥3 hepatotoxicity, grade ≥3 QTc prolongation, neurotoxicity, and cardiac toxicity between groups. In consolidation, patients receiving >10 mg/dose experienced a greater incidence of neurotoxicity (66.7% vs 22.2%; p = 0.046). Capping doses saved $24634.37/patient and reduced waste of partially-used vials. At a median follow-up of 27 months, no disease relapses occurred in either group. This represents an opportunity to improve the safety profile of this highly effective regimen.

Original languageEnglish (US)
Pages (from-to)1340-1349
Number of pages10
JournalJournal of Oncology Pharmacy Practice
Issue number6
StatePublished - Sep 2022


  • Acute promyelocytic leukemia
  • arsenic trioxide
  • capped dose
  • obesity
  • toxicity

ASJC Scopus subject areas

  • Oncology
  • Pharmacology (medical)


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