Arsenic trioxide at conventional dosage does not aggravate hemorrhage in the first-line treatment of adult acute promyelocytic leukemia
Arsenic trioxide at conventional dosage does not aggravate hemorrhage in the first-line treatment of adult acute promyelocytic leukemia
复制标题
常规剂量的三氧化二砷在成人急性早幼粒细胞白血病一线治疗中不会加重出血。
DOI：
10.1111/ejh.13018
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发表时间：
2018-04-01
影响因子：
3.1
通讯作者：
Mi, Jian-Qing
中科院分区：
文献类型：
--
作者：
Cui, Wen;Wang, Jin;Mi, Jian-Qing
目的三氧化二砷(ATO)联合全反式维甲酸(ATRA)在急性早幼粒细胞白血病(APL)一线治疗中取得巨大成功。事实上，早期死亡(ED)目前被认为是APL的一大挑战。ATO在体外有抑制血小板功能的作用，但是否通过加重出血症状而增加ED的发生率仍有待研究。方法体外观察ATO对32例完全缓解(CR)患者和4例初诊APL患者的血小板聚集和黏附的影响。结果在体外，当ATO浓度达到2mol/L时，APL患者的血小板聚集或黏附功能确实受到抑制，但在血小板计数正常的CRAPL患者中，血小板被激活时反应正常，而新诊断的血小板减少症患者的血小板反应正常。结论在APL的一线治疗中，ATO的使用是安全有效的，且不影响最终可能增加ED发生率的止血潜力。
ObjectivesThe arsenic trioxide (ATO) plus all-trans retinoic acid (ATRA) therapy has demonstrated a tremendous success in the first-line treatment of acute promyelocytic leukemia (APL). Actually, early death (ED) is currently thought as a major challenge in APL. ATO has been reported to inhibit platelet function in vitro, and whether it increases the ED rate by exacerbating the hemorrhagic symptoms remains to be investigated.MethodsEffects of ATO on platelet aggregation and adhesion were evaluated in vitro and in thirty-two complete remission (CR) and four newly diagnosed APL patients. Furthermore, concentrations of plasma total arsenic were monitored in APL patients via ICP-MS.ResultsThe inhibition of platelet function, either aggregation or adhesion, did occur in vitro when the concentration of ATO reached 2mol/L. However, in CR APL patients receiving ATO with normal platelet count, the platelets responded normally when being activated and so did those in the newly diagnosed patients with thrombocytopenia. Our data further showed that the conventional dosage of ATO reached a plasma concentration substantially below the required concentration to inhibit platelets.ConclusionsIn the first-line treatment of APL, the use of ATO is safe and effective and does not compromise the hemostatic potential that may eventually increase ED rate.