Arsenox

Arsenox has revolutionized the treatment of acute promyelocytic leukemia, offering high remission rates even in refractory cases. Its use requires specialized monitoring to manage potential toxicities and ensure optimal outcomes. Arsenox is an antineoplastic agent used primarily for the treatment of acute promyelocytic leukemia (APL). It is a highly effective targeted therapy, especially in patients with the presence of the chromosomal translocation or PML/RAR-alpha gene mutation. Arsenox induces remission by promoting apoptosis and differentiation in cancer cells.

Arsenox induces apoptosis (programmed cell death) and partial differentiation in leukemic cells. It also degrades the PML-RAR-alpha fusion protein, a key driver of APL, thereby restoring normal cell processes.

First-line treatment in combination with all-trans retinoic acid (ATRA).

For patients who are refractory to or have relapsed after standard chemotherapy.

Induction Therapy:

• 0.15 mg/kg/day intravenously until bone marrow remission or a maximum of 60 days.

Consolidation Therapy:

• 0.15 mg/kg/day IV for 25 doses over 5 weeks.

Administration Tips:

• Infuse over 1–2 hours; extend infusion to 4 hours if vasomotor reactions occur.
• Ensure hydration and monitor electrolyte levels before and during treatment.

Common side effects: Fatigue, Nausea and vomiting, Diarrhea, Peripheral neuropathy.

Serious Side Effects: Differentiation Syndrome (formerly known as retinoic acid syndrome): Symptoms include fever, dyspnea, and pulmonary infiltrates, Prolonged QT Interval: Risk of torsades de pointes or sudden cardiac death, Electrolyte Imbalance: Hypokalemia and hypomagnesemia are common.

Monitoring Requirements:

• Baseline and periodic ECGs to monitor QT interval.
• Serum electrolyte levels (potassium, magnesium, calcium).
• Liver function tests and complete blood counts.