Many side effects associated with arsenic trioxide treatment are mild but common including pruritus, nausea and vomiting, diarrhoea, headache, fatigue, arthralgia and myalgia, mildly abnormal liver function tests and electrolyte abnormalities. Cytopenias, including a decrease in neutrophil, platelet and haemoglobin levels are also common, while febrile neutropenia is rare. ECG abnormalities, particularly QTc prolongation, are common, particularly in hypokalaemic patients. Careful monitoring and supplementation to maintain adequate serum potassium and serum magnesium levels is critical, and ECG monitoring throughout treatment is required. QTc prolongation leading to torsade de pointes-type ventricular arrhythmia is rare, but may be fatal. Hyperleukocytosis (WBC greater or equal to 100 x109/L) occurs in up to 50% of patients treated with arsenic trioxide, and an APML differentiation syndrome frequently occurs, ranging in severity from isolated hyperleukocytosis to ventilation-dependant respiratory failure. Prophylaxis with corticosteroids is recommended, however APML differentiation syndrome may still occur, in which case, early recognition and prompt treatment with high dose IV corticosteroids is essential.r Peripheral neuropathy may occur and may progress to significant impairment if arsenic trioxide treatment is continued in the presence of established neuropathy.
Summary of toxicities from Shigeno et al (2005):r
© International journal of hematology 2005