Successful Treatment With Arsenic Trioxide And Retinoic Acid For Acute Promyelocytic Leukemia In A Very Elderly Patient A Case Report

Successful treatment with arsenic trioxide and retinoic acid for acute promyelocytic leukemia in a very elderly patient Boulet E 1, Bailly B1. Delrieu V1, Detry G2, Kentos A1, Ngirabacu M.-C1, Ravoet C1, Bettens S3, Van Obbergh F1, Sid S1. Department of Hematology1, Clinical Biology2 and Geriatric3, Jolimont, 7100 La Louviu00e8re Objectives: Chemotherapy free treatment with all-transretinoic-acid (ATRA) and arsenic trioxide (ATO) for promyelocytic acute leukemia (APL) has considerably improved the prognosis of APL, especially in frailer patients who wouldnu2019t be eligible for conventional chemotherapy. Methods: It seemed relevant to report the case of a 90-yearold patient successfully treated with a chemotherapy-free therapy following the 2013 protocol of Lo-Coco1 (ATO 0,15mg/kg/d and ATRA 45mg/m2/d until complete remission). Results: After comprehensive geriatric assessment was checked, treatment was started. The ATO dose was reduced by 50% (0.075 mg/kg) given the chronic kidney disease and ATRA was given at a conventional dose of 45 mg/m2. There were minor complications during induction like grade 1 differentiation syndrome, febrile neutropenia and QTc prolongation. Full blood count normalized on the 26th day, and the marrow aspirate performed showed morphological and cytogenetic remission and a decrease of PMLRARu03b1 by RT-PCR at 5,6% from baseline. She received 3 cycles of consolidation. The patient did not present any complication during consolidation treatment. At the end of the treatment, the PML-RARu03b1 fusion transcript was undetectable on peripheral blood. Conclusion: Treatment with ATRA and ATO was feasible, safe and led to a complete remission even in our very elderly patient diagnosed with acute promyelocytic leukemia. Comprehensive geriatric assessment should always be performed before initiation of the treatment.