Arsenic and Old Lace: Novel Approaches in Elderly Patients With Acute Myeloid Leukemia
Section snippets
Elderly AML Patients
AML carries a dismal prognosis in elderly patients, and conventional chemotherapy strategies are often both ineffective and toxic. The well-known combination of 7 days of infusional cytarabine and 3 days of daunorubicin has been the standard of care for many years, but is not a feasible option for many older patients with AML. Low-dose ara-C (LDAC) has been included in the literature since the 1960s and is a frequently used lower intensity alternative to conventional induction. LDAC is
Conclusions
Arsenic trioxide is a highly effective agent in APL. Its multifaceted mechanism of action and favorable toxicity profile make it an attractive choice for other hematologic malignancies, but single-agent efficacy has been limited. Treatment with arsenic trioxide and LDAC has had promising preliminary results in older patients with AML and further efforts to optimize this regimen are underway in AML, myelofibrosis, and advanced myeloproflierative diseases.
References (10)
- et al.
Arsenic trioxide induces dose- and time-dependent apoptosis of endothelium and may exert an antileukemic effect via inhibition of angiogenesis
Blood
(2000) - et al.
Phase II trial of arsenic trioxide in relapsed and refractory acute myeloid leukemia, secondary leukemia and/or newly diagnosed patients at least 65 years old
Leuk Res
(2004) On the use of arsenic in certain forms of anaemia
The Therapeutic Gazette 3rd Series
(1886)Therapeutic mule: The use of arsenic in the nineteenth century materia medica
Pharm Hist
(1975)- et al.
Mechanisms of action of arsenic trioxide
Cancer Res
(2002)
Cited by (6)
Effects of azacitidine compared with conventional care regimens in elderly (≥75 years) patients with higher-risk myelodysplastic syndromes
2010, Critical Reviews in Oncology/HematologyCitation Excerpt :There is a paucity of clinical trials in elderly patients and a general lack of data regarding outcomes of cytotoxic therapy for older patients with higher-risk MDS [9]. Even the definition of “elderly” varies widely, with patients over age 60, 65, or 70 years of age considered “elderly” in published studies [10–12]. In the absence of clear guiding data, clinical decisions may be extrapolated from data in older patients with AML [12], as it has been suggested that in older patients, higher-risk MDS and AML are two points on the biological continuum of the same disease [2].
Anti-cancer drugs interfere with intracellular calcium signaling
2009, NeuroToxicologySafety and efficacy of low-dose intravenous arsenic trioxide in systemic lupus erythematosus: an open-label phase IIa trial (Lupsenic)
2021, Arthritis Research and TherapyRealgar-induced apoptosis of cervical cancer cell line siha via cytochrome C release and caspase-3 and caspase-9 activation
2012, Chinese Journal of Integrative MedicineExploring old drugs for the treatment of hematological malignancies
2011, Current Medicinal ChemistryAdvances in treatment of acute myeloid leukemia in the elderly
2009, Acta Academiae Medicinae Sinicae
STATEMENT OF CONFLICT OF INTEREST: Research support/Principal Investigator: Cephalon; Consultant/Scientific Advisory Board: Cephalon.