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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Abnormal Heart Rhythm in Patients with Leukemia Treated with Arsenic Trioxide
5 December 2000 | Volume 133 Issue 11 | Page S59
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician.
The summary below is from the full report titled "Prolongation of the QT Interval and Ventricular Tachycardia in Patients Treated with Arsenic Trioxide for Acute Promyelocytic Leukemia." It is in the 5 December 2000 issue of Annals of Internal Medicine (volume 133, pages 881-885). The authors are K Ohnishi, H Yoshida, K Shigeno, S Nakamura, S Fujisawa, K Naito, K Shinjo, Y Fujita, H Matsui, A Takeshita, S Sugiyama, H Satoh, H Terada, and R Ohno.
What is the problem and what is known about it so far?
Acute promyelocytic leukemia (APL) is a cancer of the blood. Arsenic trioxide is effective in treating cases of APL that have not responded to other therapies. Abnormal heart rhythms are common in patients with arsenic poisoning, so there is concern that dangerous side effects might occur when arsenic is used to treat APL. A previous report found that heart rhythm abnormalities occurred in only 8 of 47 patients with leukemia receiving arsenic; none of these heart rhythms was life-threatening. However, another report described a patient with APL who required a pacemaker after arsenic treatment.
Why did the researchers do this particular study?
The researchers noticed an abnormality in the electrocardiogram of the first APL patient they treated with arsenic. They therefore decided to monitor a series of patients to see how often these abnormalities occur.
Who was studied?
The study included 8 patients with APL who received arsenic therapy at a teaching hospital in Japan.
How was the study done?
The patients were given arsenic trioxide through an intravenous catheter (a small tube inserted into a vein) daily for a maximum of 60 days. Treatment was stopped earlier if the leukemia went into complete remission, which means that no signs of the cancer could be found in the blood. Patients who went into remission were given an additional 25 days of arsenic therapy 3 to 6 weeks after the initial treatment. During arsenic treatment, the researchers monitored patients with ambulatory electrocardiography, which records the electrical activity and rhythm of the heart continuously while patients go about their usual activities. Patients also had standard electrocardiography once per week. This test measures the heart's electrical activity over a short period while the patient is resting.
What did the researchers find?
Of the 8 patients, 5 went into remission. An abnormality of the electrocardiogram (prolonged QT interval) was noted in 4 of the 8 patients before they started arsenic treatments. This abnormality occurred in all of the patients during the first round of arsenic treatment and in 3 of the 4 patients who received another course of treatment after remission. Four patients developed types of abnormal heart rhythm that required treatment with drugs.
What were the limitations of the study?
The number of patients studied was quite small, and half of the patients had abnormal electrocardiograms before receiving the drug. Moreover, the researchers did not study a control group of patients with APL who did not receive arsenic; the report therefore does not definitely prove that arsenic caused the heart abnormalities.
What are the implications of the study?
This report suggests that arsenic trioxide therapy can trigger abnormal heart rhythms and that patients with APL should have their heart rhythms monitored carefully while they are receiving arsenic therapy.
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