Page 25 - Delaware Medical Journal - February 2016
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MEDICAL STUDENT ABSTRACTS
all-trans retinoic acid (ATRA) 45 mg/m2 p.o. every 12 hours with arsenic trioxide 0.15mg/kg IV daily. After completing a 28-day Her FISH after induction was still positive for PML-RAR alpha in 78 percent of cells. She was discharged home and began outpatient consolidation therapy of arsenic trioxide 0.15mg/kg IV 5 days per week, four weeks on/four weeks off, for a total of four courses and ATRA 45 mg/m2 p.o. two weeks on/two weeks off for a total of seven courses, for a duration of 28 weeks. Our patient has completed two cycles of consolidation and continues to tolerate the regiment with the only side effect of grade I neuropathy.
Discussion: The standard of care for APL has been ATRA with chemotherapy (anthracycline with or without cytarabine), but
increased toxicity when used in older adults (>60 y).3 Recent research has suggested the preferential use of ATRA with arsenic trioxide as a non-inferior alternative for older adults, as this regimen places a higher value on lesser myelosuppression and cardiac toxicity.4,5 Our case report tolerate the side effects of chemotherapy. Especially for older patients with APL, it is important to focus on improving the overall treatment experience and increasing quality of life traditional options with considerably less toxicity. Further research on the long-term effects and cost-effectiveness of this new regimen are necessary.
Honorable Mentions:
Arterial Thrombosis Presenting As Renal Colic Jeffrey Muenzer, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Penn.
Variant of Guillain-Barre Syndrome (GBS)
Dipa Avichal, OMS IV, Rowan School of Osteopathic Medicine; and Lynnae Duffalo, MD, Department
of Medicine at Christiana Care Hospital System, Newark, Del.
H emolytic Anemia – Drug-Induced or Autoimmune?
Nicole C. Finelli, OMS IV, Philadelphia College of Osteopathic Medicine; and Matthew L. Barrett, DO, Christiana Care Health System, Newark, Del.
Unearthing a Unifying Diagnosis
Kristofer Lambert, MS-IV, Philadelphia College of Osteopathic Medicine; and John Piper, MD, Infectious Diseases, Christiana Care Health System, Newark, Del.
A Case of Space Occupying Brain Lesions in a Patient with Untreated HIV, Undiagnosed with Stereotactic Brain Biopsy
Laura Methvin, MS-IV, Sidney Kimmel Medical College, Thomas Jefferson University.
Recurrent Fusobacterium Necrophorum Pharyngitis Alissa Werzen, MS IV, Sidney Kimmel Medical College of Thomas Jefferson University; John Piper MD, Christiana Care Health System
CONTRIBUTING AUTHOR
■ CHERYL JACKSON, MD, FACP is the Director of the Fourth Year Medical Student Program at Christiana Care Health System.
REFERENCES:
1. Swerdlow SH, Campo E, Harris NL, et al. World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues, IARC Press, Lyon 2008.
2. Hillestad LK. Acute promyelocytic leukemia. Acta Med Scand. 1957;159:189-194.
3. Sanz MA, Vellenga E, Rayón C, et al. All-trans retinoic acid and anthracycline monochemotherapy for the treatment of elderly patients with acute promyelocytic leukemia. Blood. 2004;104:3490-3493.
4. Lo-Coco F, Avvisati G, Vignetti M, et al. Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med. 2013;369:111-121.
5. Goodman A. Chemotherapy-free Regimen Successful in Acute Promyelocytic Leukemia. ASCO Post. 2013;4:3.
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