Arsenic Trioxide

Specialist use — must be administered under the supervision of a physician experienced in the management of acute leukaemias. Same dose recommended for adults and elderly. Acute promyelocytic leukaemia (APL). Newly diagnosed low-to-intermediate risk APL — Induction: 0.15 mg/kg/day daily until complete remission; discontinue if not achieved by day 60. Consolidation: 0.15 mg/kg/day, 5 days per week, 4 weeks on and 4 weeks off, for a total of 4 cycles. Relapsed/refractory APL — Induction: 0.15 mg/kg/day daily until complete remission (<5% blasts, no evidence of leukaemic cells); discontinue if not achieved by day 50. Consolidation: begins 3-4 weeks after induction; 0.15 mg/kg/day for 25 doses given 5 days per week followed by 2 days interruption, repeated for 5 weeks. Interrupt for any toxicity grade 3 or greater (NCI Common Toxicity Criteria) possibly related to treatment; resume at 50% of the preceding daily dose, escalating back to 100% if no recurrence within 7 days. A central venous catheter is not required; patients must be hospitalised at the beginning of treatment. Caution in hepatic or renal impairment (no data across groups).