Case Report
Bradycardia during Induction Therapy with All-trans Retinoic Acid in Patients with Acute Promyelocytic Leukemia: Case Report and Literature Review
Table 1
Case reports of all-trans retinoic acid-associated bradycardia.
| | | Age | Sex | Initial WBC (mm3) | Indication of ATRA | ATRA dose (mg/m2) | Concurrent chemotherapy | Onset (days) | ECG change | Pacemaker | Response after discontinuation of ATRA | Response after rechallenge | DS |
| | Maruhashi et al. [10] | 3 | M | NA | Induction | 45 | NA | 4 | Sinus bradycardia | NA | Still arrhythmia | Arrhythmia augmented | NA |
| | Yamauchi et al. [11] | 46 | M | NA | Induction | 45 | Enocitabine | 25 | CAVB | TPM | NSR after 15 days | NA | NA | | Mitoxantrone |
| | Dhar and Barman [12] | 16 | F | 2,000 | Induction | 45 | NA | 9 | 2nd degree AVB | No | ATRA was continued and steroid was given→NSR | Yes |
| | McGregor et al. [13] | 28 | F | 9,800 | Induction | 45→22.5 | Idarubicin | 5 | Junctional bradycardia | No | NSR after 3 days | No more bradycardia | Yes |
| | Karakatsanis et al. [14] | 64 | M | NA | Induction | NA | Idarubicin | 8 | Sinus bradycardia | No | ATRA was continued and bradycardia resolved spontaneously | NA |
| | Shih and Wu [15] | 57 | M | 1,600 | Induction | 45 | NA | 15 | CAVB | TPM | Sinus rhythm after 4 days (under TPM) | 75% dose→still AVB | No |
| | This case | 41 | M | 15,820 | Induction | 45 | Idarubicin
ATO | 11 | CAVB | TPM | HR partially recovered after interruption for 3 doses | 50% dose→CAVB with DS→hold ATRA, insert TPM→1st degree AVB→25% dose→bradycardia→75% dose→NSR | Yes |
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ATO: arsenic trioxide; ATRA: all-trans retinoic acid; AVB: atrioventricular block; CAVB: complete atrioventricular block; DS: differentiation syndrome; ECG: electrocardiogram; F: female; HR: heart rate; M: male; NA: not available; NSR: normal sinus rhythm; TPM: temporary pacemaker; WBC: white blood cell.
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