How it Works

Arsenic trioxide is a treatment for acute promyelocytic leukemia (APL), a subtype of acute myeloid leukemia (AML). APL is characterized by an increase in the number of immature blood cells called promyelocytes in the bone marrow and is caused by a chromosomal abnormality known as the t(15;17) translocation.

The exact function of this Arsenic trioxide is not yet completely understood, but it is suspected of inhibiting the growth and survival of cancer cells by tampering with their DNA, leading to cancer cell death (apoptosis). It is typically used in combination with all-trans retinoic acid (ATRA) to treat APL. ATRA promotes the differentiation of promyelocytes into mature white blood cells, while arsenic trioxide helps to kill the remaining cancer cells.

How it’s Administered

• Induction: intravenous daily in combination with all-trans retinoic acid (ATRA)until bone marrow remission. For less than 60 days
• Consolidation: intravenous daily for 5 days per week during weeks 1-4 of each 8-week cycle for a total of 4 cycles in combination with tretinoin.

• Relapsed/ refractory APL: Induction: intravenous daily in combination with all-trans retinoic acid (ATRA) until bone marrow remission. For less than 60 days
• Consolidation:  intravenous daily for 25 doses over a period of up to 5 weeks. 

Who Should Take Arsenic Trioxide

• Used for induction of remission and consolidation in patients with acute promyelocytic leukemia (APL) and whose APL is characterized by the presence of the t(15;17) translocation or PML/RAR-alpha gene expression
• Patients with a recent diagnosis of acute promyelocytic leukemia (APL), 
• Patients with APL that have not responded to other treatments or that have relapsed
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• Patients with prior retinoid and anthracycline chemotherapy, refractory or relapsed acute promyelocytic leukemia. 
• Patients with leukemia that are unresponsive to first-line agents. 
• Patients with prior retinoid and anthracycline chemotherapy, refractory or relapsed acute promyelocytic leukemia. 
• Patients with leukemia that are unresponsive to first-line agents. 

Who Shouldn’t Take Arsenic Trioxide

• Pregnant women. It is important to inform your healthcare provider if you are pregnant, or planning to become pregnant before starting treatment, as it may cause harm to the fetus. 
• Patients diagnosed with Long QT syndrome (LQTS). A rare inherited heart rhythm disorder that can cause potentially life-threatening irregular heartbeats, known as arrhythmias.
• Breastfeeding women should suspend breastfeeding if they start taking this medication. 
• People who are allergic to the medication or any of its components.

The Most Common Side Effects of Taking Arsenic Trioxide Include:

• Gastrointestinal issues like: nausea, abdominal pain, vomiting, diarrhea, 
• Difficulty breathing, cough, swelling, insomnia, dermatitis, sore throat
• QTc interval prolongation in electrocardiogram
• Rigors (a sudden feeling of cold with shivering accompanied by a rise in temperature, often with copious sweating, especially at the onset or height of a fever.)
• Fatigue, headache, increased heart rate (tachycardia), raised body temperature, joint pain, numbness, and itching 
• Low potassium levels, high glucose levels, and low magnesium level in the blood 
• Low white blood cells counts 
• Differentiation syndrome is a very serious side effect that is preventable with proper monitoring and immediate treatment. This syndrome is a reaction between the drug and leukemia, which produces fever, difficulty breathing, weight gain, lung and heart problems. It is generally treated with high-dose steroids. In most cases, treatment will continue. The syndrome usually occurs during the first month of treatment, with some cases reported following the first dose.

Commonly Used in Acute Myeloid Leukemia With

• All-Trans Retinoic Acid (ATRA), to treat APL
• Anthracyclines (such as daunorubicin or idarubicin) and/or cytarabine, to treat APL.
• As a single drug therapy.

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Date Last Updated: 12/22/22