Cardiac monitoring of patients receiving arsenic trioxide therapy

Dilip Unnikrishnan, Janice P. Dutcher, Susan Garl, Nikita Varshneya, Richard J. Lucariello, Peter H. Wiernik

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Arsenic trioxide (ATO) is approved for the treatment of acute promyelocytic leukaemia and is under investigation for other malignancies. We report the cardiac findings in 18 patients with haematologic malignancies treated with ATO and assess the role of cardiac factors in fluid retention syndrome observed during ATO therapy. Based on initial observations in 10 patients treated with ATO, cardiac functions in the subsequent eight patients were evaluated prospectively. Evaluation included pre- and during-treatment electrocardiograms, Holter monitoring, echocardiograms, multigated acquisition scan and cardiac stress tests if indicated. All eight patients developed fluid retention during ATO, evidenced by pulmonary congestion, oedema and pleural/pericardial effusions. No cardiac factors were identified that contributed to fluid retention. Six patients had prolonged corrected QT (QTc) compared with baseline, three developed ventricular tachycardia. Sinus tachycardia, ventricular premature contractions, and non-sustained ventricular/supraventricular tachycardia were seen during ATO treatment. Fluid retention and cardiac events did not correlate with the dose or total amount of ATO or prior anthracycline therapy. In summary, fluid overload during ATO therapy does not appear to be cardiac in origin but appears to be drug-related, and may reflect cytokine-induced capillary leak. QTc prolongation, transient arrhythmias and clinically significant arrhythmias were seen with therapeutic doses of ATO.

Original languageEnglish (US)
Pages (from-to)610-617
Number of pages8
JournalBritish Journal of Haematology
Volume124
Issue number5
DOIs
StatePublished - Mar 2004
Externally publishedYes

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Physiologic Monitoring
Therapeutics
Ventricular Tachycardia
Cardiac Arrhythmias
Sinus Tachycardia
arsenic trioxide
Acute Promyelocytic Leukemia
Ambulatory Electrocardiography
Supraventricular Tachycardia
Ventricular Premature Complexes
Pericardial Effusion
Anthracyclines
Pulmonary Edema
Hematologic Neoplasms
Pleural Effusion
Exercise Test
Electrocardiography
Cytokines

Keywords

  • Arsenic trioxide
  • Cardiac function
  • Fluid overload
  • Toxicity
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Hematology

Cite this

Cardiac monitoring of patients receiving arsenic trioxide therapy. / Unnikrishnan, Dilip; Dutcher, Janice P.; Garl, Susan; Varshneya, Nikita; Lucariello, Richard J.; Wiernik, Peter H.

In: British Journal of Haematology, Vol. 124, No. 5, 03.2004, p. 610-617.

Research output: Contribution to journalArticle

Unnikrishnan, D, Dutcher, JP, Garl, S, Varshneya, N, Lucariello, RJ & Wiernik, PH 2004, 'Cardiac monitoring of patients receiving arsenic trioxide therapy', British Journal of Haematology, vol. 124, no. 5, pp. 610-617. https://doi.org/10.1111/j.1365-2141.2003.04817.x
Unnikrishnan, Dilip ; Dutcher, Janice P. ; Garl, Susan ; Varshneya, Nikita ; Lucariello, Richard J. ; Wiernik, Peter H. / Cardiac monitoring of patients receiving arsenic trioxide therapy. In: British Journal of Haematology. 2004 ; Vol. 124, No. 5. pp. 610-617.
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