The impact of oral arsenic and all-trans-retinoic acid on coagulopathy in acute promyelocytic leukemia

• Published in: Leukemia research 2018-02, Vol.65, p.14-19
• Main Authors: Zhu, Hong-Hu, Guo, Zhi-Ping, Jia, Jin-Song, Jiang, Qian, Jiang, Hao, Huang, Xiao-Jun
• Format: Article
• Language: English
• Subjects: Acute; Administration, Oral; Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Arsenic; Arsenic Trioxide - administration & dosage; Arsenic Trioxide - therapeutic use; Blood Transfusion; Disseminated intravascular coagulation; Disseminated Intravascular Coagulation - complications; Disseminated Intravascular Coagulation - drug therapy; Disseminated Intravascular Coagulation - physiopathology; Disseminated Intravascular Coagulation - therapy; Drugs, Chinese Herbal - administration & dosage; Drugs, Chinese Herbal - therapeutic use; Female; Humans; Leukemia; Leukemia, Promyelocytic, Acute - blood; Leukemia, Promyelocytic, Acute - complications; Leukemia, Promyelocytic, Acute - drug therapy; Male; Middle Aged; Mitoxantrone - therapeutic use; Platelet Transfusion; Promyelocytic; Retrospective Studies; Tretinoin - administration & dosage; Tretinoin - therapeutic use; Young Adult
• ISSN: 0145-2126; 1873-5835
• DOI: 10.1016/j.leukres.2017.11.009

•Hemostatic alterations could be reversed by RIF and ATRA plus chemotherapy.•RIF and ATO showed similar effects on coagulopathy recovery in APL patients.•RIF had a potential benefit on coagulopathy recovery for subclinical DIC patients. The aim of our study was to evaluate the impact of oral arsenic (the realgar-indigo naturalis formula, RIF) and all-trans retinoic acid (ATRA) on coagulopathy in acute promyelocytic leukemia (APL) compared with intravenous arsenic trioxide (ATO) and ATRA during induction. Mitoxantrone was added to all the patients at a dose of 1.4mg/m2 per day for 5–7 days. D-dimer levels, prothrombin time (PT), fibrinogen (Fbg) levels and the platelet count were comparably analyzed among 83 newly diagnosed APL patients treated with RIF (n=45) or with ATO (n=38). Since induction therapy with RIF and ATRA, the median levels of Fbg, PT and platelets were recovered to the normal range within 4days, 10days and 28days, respectively. The last day of platelet and plasma transfusion was day 12 (range: 0–24 days) and day 3 (range: 0–27 days), respectively. Among the 42 patients with a disseminated intravascular coagulation (DIC) score=4, the consumption of transfused platelets was less in the RIF group than that in the ATO group (P=0.037). In the 17 patients with a DIC score