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

Kensuke Naito, Miki Kobayashi, Naohi Sahara, Kazuyuki Shigeno, Satoki Nakamura, Kaori Shinjo, Tadasu Tobita, Akihiro Takeshita, Ryuzo Ohno, Kazunori Ohnishi

Division of Hematology, Department of Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan. kensuke.naito@nifty.com

International journal of hematology 2006 May

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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.

Citation

Kensuke Naito, Miki Kobayashi, Naohi Sahara, Kazuyuki Shigeno, Satoki Nakamura, Kaori Shinjo, Tadasu Tobita, Akihiro Takeshita, Ryuzo Ohno, Kazunori Ohnishi. Two cases of acute promyelocytic leukemia complicated by torsade de pointes during arsenic trioxide therapy. International journal of hematology. 2006 May;83(4):318-23