Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2020; 8(21): 5347-5352
Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5347
Successful treatment of relapsed acute promyelocytic leukemia with arsenic trioxide in a hemodialysis-dependent patient: A case report
Hee Jeong Lee, Sang-Gon Park
Hee Jeong Lee, Department of Hemato-Oncology, Chosun University Hospital, Gwang-ju 501-717, South Korea
Sang-Gon Park, Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 61453, South Korea
Author contributions: Lee HJ contributed mainly to the writing of the manuscript; Park SG was involved in supervision; all authors have approved this version for publication.
Supported by Research fund from Chosun University, 2020.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: We have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sang-Gon Park, MD, PhD, Associate Professor, Doctor, Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, South Korea. sgpark@chosun.ac.kr
Received: June 1, 2020
Peer-review started: June 1, 2020
First decision: September 24, 2020
Revised: October 6, 2020
Accepted: October 19, 2020
Article in press: October 19, 2020
Published online: November 6, 2020
Abstract
BACKGROUND

Arsenic trioxide (ATO) is recommended for patients who do not achieve molecular remission or who have molecular or morphologic relapse. However, there are no guidelines for adjusting ATO dosage in patients with severe renal failure or on dialysis. Herein, we report the successful treatment of relapsed acute promyelocytic leukemia (APL) in a patient on hemodialysis with ATO single agent and review the cases in literature.

CASE SUMMARY

A 46-year-old woman who has been on hemodialysis to chronic glomerulone-phritis for 15 years visited our hospital for pancytopenia. She had been seen for pancytopenia 3 years ago and had been diagnosed with APL. She also received chemotherapy for APL but unfortunately was lost to follow-up after her second consolidation chemotherapy. She was noted to have pancytopenia by her nephrologist during hemodialysis 1 mo ago. Bone marrow biopsy and reverse transcriptase-polymerase chain reaction (RT-PCR) tests revealed a diagnosis of relapsed APL. Treatment for relapsed APL with ATO single agent was started and she achieved molecular remission after administering 24 doses of ATO. Thus far, four consolidation therapies have been performed with the ATO single agent, and, to date, the molecular remission has been maintained as negative promyelocytic leukemia/retinoic acid receptor-α fusion gene as confirmed by RT-PCR testing for two years.

CONCLUSION

This is a rare case of relapsed APL successfully treated with the single agent ATO in a patient on hemodialysis.

Keywords: Arsenic trioxide, Acute promyelocytic leukemia, Pancytopenia, Hemodialysis, Promyelocytic leukemia/retinoic acid receptor-α fusion gene, Case report

Core Tip: Arsenic trioxide (ATO) is recommended for patients who do not achieve molecular remission or who have molecular or morphologic relapse. However, there are no guidelines for adjusting ATO dosage in patients with severe renal failure or on dialysis. Herein, we report the successful treatment of relapsed acute promyelocytic leukemia in a patient on hemodialysis with ATO single agent and review the cases in literature.