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Zhao Q, Guo M, Hostetter TH, Chen H, Lin L, Hai X. Effect of renal impairment on arsenic accumulation, methylation capacity, and safety in acute promyelocytic leukemia (APL) patients treated with arsenic trioxide. Expert Rev Clin Pharmacol 2021; 14:1173-1182. [PMID: 34181499 DOI: 10.1080/17512433.2021.1938549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Arsenic trioxide (ATO) was successfully applied to treat acute promyelocytic leukemia (APL).Methods: Inorganic arsenic (iAs), monomethylarsonic acid (MMAV) and dimethyarsinic acid (DMAV) in plasma of 143 APL patients with different renal function were determined. Arsenic methylation capacity was evaluated by iAs%, MMAV%, DMAV%, primary methylation index (PMI, MMAV/iAs), and secondary methylated index (SMI, DMAV/MMAV). Arsenic accumulation with administration frequency were explored. Moreover, safety assessments were performed.Results: Compared with normal renal function, MMAV and DMAV concentrations increased 1.5-4 fold in moderate and severe renal impairment groups, iAs increased 1.3-1.7 fold. APL patients with renal impairment showed lower iAs%, but higher DMAV% and PMI in plasma than those with normal renal function (P < 0.05). MMAV, DMAV, and tAs apparently accumulated with administration frequency in moderate and severe renal dysfunction groups. The incidence of QTc interval prolongation and liver injury increased with the increasing severity of renal impairment.Conclusion: Renal dysfunction may increase exposure to arsenic and arsenic accumulation and affect methylation capacity, then the clinical safety in APL patients treated with ATO. Arsenic-level monitoring and dosing regimen adjustment should be considered in APL patients with moderate and severe renal dysfunction.
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Affiliation(s)
- Qilei Zhao
- Department of Pharmacy, First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Meihua Guo
- Department of Pharmacy, First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Thomas H Hostetter
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Hongzhu Chen
- Department of Pharmacy, First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Liwang Lin
- Department of Pharmacy, First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Xin Hai
- Department of Pharmacy, First Affiliated Hospital, Harbin Medical University, Harbin, China
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Gao C, Fan S, Hostetter TH, Wang W, Li J, Guo M, Zhou J, Hai X. Effect of continuous venovenous haemodialysis on outcome and pharmacokinetics of arsenic species in a patient with acute promyelocytic leukaemia and acute kidney injury. Br J Clin Pharmacol 2019; 85:849-853. [PMID: 30677159 DOI: 10.1111/bcp.13875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/27/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022] Open
Abstract
This study presents outcome and pharmacokinetics of arsenic trioxide (ATO) metabolites in patients on continuous venovenous haemodialysis (CVVHD). Of 3 acute promyelocytic leukaemia patients receiving CVVHD in management of acute kidney injury, only 1 patient was included. The patient presented disseminated intravascular coagulation and acute kidney injury before induction therapy was conducted. CVVHD was performed and ATO was initiated. Species of ATO metabolites in plasma and effluent were analysed using high performance liquid chromatography-hydride generation-atomic fluorescence spectrometry. Plasma concentrations of AsIII , monomethylarsonic acid and dimethylarsinic acid with CVVHD were lower than those without CVVHD. Area under the concentration-time curve from 0 to the last sample with quantifiable concentration of AsIII without CVVHD was significantly higher than that with CVVHD (292.10 ng h/mL vs 195.86 ng h/mL, P = .037), which were not observed for monomethylarsonic acid and dimethylarsinic acid. Dialysate saturation of arsenic species was remarkable, especially for AsIII . Complete remission was achieved and renal function recovered. In this study, ATO can be used safely and effectively to treat acute promyelocytic leukaemia patients undergoing CVVHD without dose adjustment.
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Affiliation(s)
- Chunlu Gao
- Department of Pharmacy, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Shengjin Fan
- Department of Hematology, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Thomas H Hostetter
- Department of Medicine, Case Western University School of Medicine, Cleveland, OH, USA
| | - Wenjing Wang
- Department of Pharmacy, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Jing Li
- Department of Pharmacy, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Meihua Guo
- Department of Pharmacy, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Jin Zhou
- Department of Hematology, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
| | - Xin Hai
- Department of Pharmacy, the First Hospital, Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, China
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