TY - JOUR
T1 - Acute kidney injury in acute promyelocytic leukemia
T2 - a possible adverse effect of high dose arsenic trioxide in obese patients
AU - Jen, Wei Ying
AU - Sasaki, Koji
AU - Rausch, Caitlin R.
AU - DiNardo, Courtney D.
AU - Kadia, Tapan M.
AU - Yilmaz, Musa
AU - Borthakur, Gautam
AU - Alvarado, Yesid
AU - McCue, David
AU - McCue, Deborah
AU - Kantarjian, Hagop M.
AU - Ravandi, Farhad
N1 - Publisher Copyright:
© 2023 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2024
Y1 - 2024
N2 - Arsenic trioxide (ATO)-based regimens are standard in acute promyelocytic leukemia (APL). ATO-related nephrotoxicity has not been reported. We reviewed APL patients treated with ATO to identify cases of acute kidney injury (AKI). Clinically significant cases were characterized. Multivariate analysis was performed to identify predictors of idiopathic, clinically significant AKI. One hundred and eight patients were included. ATO dose was 0.15 mg/kg/day using actual body weight with no dose cap. Thirty-one (28.7%) AKI cases were identified, 10 (32.3%) clinically significant. Six were idiopathic; five required dialysis. The proportion with significant, idiopathic AKI was 15.8% in patients receiving >15mg ATO versus 0% in those receiving ≤15mg (p = 0.001). On multivariate analysis, only ATO dose was a significant predictor of clinically significant AKI (odds ratio of 1.91, 95%CI, 1.19–3.07, p = 0.007). High-dose ATO may be associated with significant nephrotoxicity. We recommend that ATO dose be capped at 15 mg to minimize toxicity for this curable disease.
AB - Arsenic trioxide (ATO)-based regimens are standard in acute promyelocytic leukemia (APL). ATO-related nephrotoxicity has not been reported. We reviewed APL patients treated with ATO to identify cases of acute kidney injury (AKI). Clinically significant cases were characterized. Multivariate analysis was performed to identify predictors of idiopathic, clinically significant AKI. One hundred and eight patients were included. ATO dose was 0.15 mg/kg/day using actual body weight with no dose cap. Thirty-one (28.7%) AKI cases were identified, 10 (32.3%) clinically significant. Six were idiopathic; five required dialysis. The proportion with significant, idiopathic AKI was 15.8% in patients receiving >15mg ATO versus 0% in those receiving ≤15mg (p = 0.001). On multivariate analysis, only ATO dose was a significant predictor of clinically significant AKI (odds ratio of 1.91, 95%CI, 1.19–3.07, p = 0.007). High-dose ATO may be associated with significant nephrotoxicity. We recommend that ATO dose be capped at 15 mg to minimize toxicity for this curable disease.
KW - Obesity
KW - PA17-0033
KW - arsenic dosing
KW - severe acute kidney injury
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U2 - 10.1080/10428194.2023.2290467
DO - 10.1080/10428194.2023.2290467
M3 - Article
C2 - 38054837
AN - SCOPUS:85179922265
SN - 1042-8194
VL - 65
SP - 378
EP - 382
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 3
ER -