In the treatment of APL patients, the side effects of As2O3 appear to be mild. In contrast to many other chemotherapeutic agents, it causes no myelosuppression.
Instead, As2O3 induces leukocytosis in about 50% of patients.11,13,36 The leuko-cytosis can resolve in all cases without chemotherapy.87 The APL patients on As2O3 can also develop retinoic acid syndrome (RAS)-like symptoms such as fever, skin rash and edema, which can be readily relieved by steroid administra-tion.88 Other mild effects were reported in about 40-50% of relapsed patients, including fatigue, fever, edema, nausea, anorexia, diarrhea, emesis, headache, insomnia, cough, dyspnea, dermatitis, tachycardia, pain, hypokalemia, hypo-magnesemia and hyperglycemia. The most common (>10%) Grade 3 and 4 adverse events were abdominal pain, epistaxis, dyspnea, hypoxia, bone pain, thrombocytopenia, neutropenia, hypokalemia and hyperglycemia.11,36,89 In a clinical trial, prolonged QT intervals (the time intervals for the contraction of the ventricle from the beginning of the Q wave to the end of T wave; a prolonged QT interval indicates cardiac toxicity) were observed in all patients during induction therapy with As2O3 and ventricular premature contractions were noticed during eight of the twelve courses of therapy.90 QT prolongation was also observed in 38% of patients in another clinical study.89 The prolonged QT intervals could return to baseline following cessation of As2O3.
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