The Arsenic Concentration In Cerebrospinal Fluid When Treating Acute Promyelocytic Leukemia With Arsenic Trioxide

Acute promyelocytic leukemia(APL) used to be one of thecritical and fulminant human malignancies,usually accompanied witha life-threatening hemorrhagic diathesis. Malignant promyelocytesgrow out of control and fail to differentiate into normal maturegranulocytes. Typical promyelocytes possess a unique chromosometranslocation t(15;17),resulting in a chimeric gene,promyelocyticleukemia-retinoic acid receptors (PML-RARα). In China the treatmentof APL has been extensively studied and achieved prominent results.All-trans retinoic acid (ATRA) and arsenic compounds dramaticallyand specifically improved the clinical course and the long-termoutcome of patients with APL.The dramatic effect of arsenic trioxide in the therapy of APL isgenerally accepted all over the world, but reports about the variationof arsenic concentration in the patients' serum and cerebrospinal fluidwas very few. So we evaluated the arsenic concentration in 32 samplesof serum and cerebrospinal fluid to find out whether arsenic trioxidecan pass through the blood-cerebral barrier or not, and identify theessentiality of lumbar puncture and intrathecal injection to preventnervous system leukemia.Objective: To find out whether arsenic trioxide can pass throughthe blood-cerebral barrier or not, and identify the essentiality oflumbar puncture and intrathecal injection to prevent nervous systemleukemia.Methods: We chose 32 APL patients who were undergo theirinitial treatments in our hospital, all of whom had neither been foundsuffer from the central nervous system leukemia (CNSL) before thehematological complete remission was achieved, nor undertakenprophylactic treatment of CNSL. Arsenic trioxide was given to allthese patients. We used atomic fluorophotometer to examine theconcentrations of arsenic in serum and cerebrospinal fluid respectively28 days after the patients' injecting arsenic trioxide. At the same time,we examined 8 samples of normal people's cerebrospinal fluid. Andwe analysed the differences between the two groups by t test.Results: We found that among most APL patients theconcentrations in cerebrospinal fluids were lower than those in serum,and the difference of was conspicuous. However, the concentrations ofcerebrospinal fluids in the APL patients and those in normal personswere semblable.Conclusion: Arsenic trioxide can not pass through theblood-cerebral barrier, and the concentration of arsenic trioxide incerebrospinal fluid was too low to protect the patients from centralnervous system leukemia. So APL patients should take lumbarpuncture and intrathecal injection to prevent nervous system leukemia.