Gail J Roboz1, Ellen K Ritchie2, Rebecca F Carlin2, Michael Samuel2, Leanne Gale2, Juliette L Provenzano-Gober2, Tania J Curcio2, Eric J Feldman2, Paul D Kligfield2. 1. Gail J. Roboz, Ellen K. Ritchie, Tania J. Curcio, Eric J. Feldman, and Paul D. Kligfield, Weill Medical College of Cornell University and New York-Presbyterian Hospital; Michael Samuel, Montefiore Medical Center and Albert Einstein College of Medicine; Juliette L. Provenzano-Gober, New York University, New York, NY; Rebecca F. Carlin, Greater Baltimore Medical Center, Baltimore, MD; and Leanne Gale, University of Pennsylvania, Philadelphia, PA. gar2001@med.cornell.edu. 2. Gail J. Roboz, Ellen K. Ritchie, Tania J. Curcio, Eric J. Feldman, and Paul D. Kligfield, Weill Medical College of Cornell University and New York-Presbyterian Hospital; Michael Samuel, Montefiore Medical Center and Albert Einstein College of Medicine; Juliette L. Provenzano-Gober, New York University, New York, NY; Rebecca F. Carlin, Greater Baltimore Medical Center, Baltimore, MD; and Leanne Gale, University of Pennsylvania, Philadelphia, PA.
Abstract
PURPOSE: Arsenic trioxide (ATO) is a highly effective agent for the treatment of acute promyelocytic leukemia (APL). QT interval prolongation is common with ATO and can pose a barrier to effective administration. The objective of this study was to characterize the prevalence, management, and clinical consequences of QT prolongation in a large cohort of patients treated with ATO. PATIENTS AND METHODS: We analyzed 3,011 electrocardiograms from 113 patients with non-APL acute myeloid leukemia and myelodysplastic syndrome who were treated on a previously reported clinical trial. QT intervals were assessed using four different correction formulas, and data were correlated with clinical parameters and treatment with ATO. RESULTS: There were no clinically significant cardiac events in the study population. Of those receiving ATO therapy, 29 patients (26%) had rate-uncorrected QT values above 470 ms and 13 (12%) had values exceeding 500 ms. With the commonly used Bazett rate correction formula, 102 patients (90%) had QTc greater than 470 ms, including 74 (65%) above 500 ms. By using alternative rate correction formulas, only 24% to 32% of patients had rate-corrected QT intervals above 500 ms. CONCLUSION: QT interval prolongation is common with ATO treatment, but clinically significant arrhythmias are rare and can be avoided with appropriate precautions. Use of the Bazett correction may result in unnecessary interruptions in ATO therapy, and alternative rate correction formulas should be considered for routine electrocardiographic monitoring.
PURPOSE:Arsenic trioxide (ATO) is a highly effective agent for the treatment of acute promyelocytic leukemia (APL). QT interval prolongation is common with ATO and can pose a barrier to effective administration. The objective of this study was to characterize the prevalence, management, and clinical consequences of QT prolongation in a large cohort of patients treated with ATO. PATIENTS AND METHODS: We analyzed 3,011 electrocardiograms from 113 patients with non-APLacute myeloid leukemia and myelodysplastic syndrome who were treated on a previously reported clinical trial. QT intervals were assessed using four different correction formulas, and data were correlated with clinical parameters and treatment with ATO. RESULTS: There were no clinically significant cardiac events in the study population. Of those receiving ATO therapy, 29 patients (26%) had rate-uncorrected QT values above 470 ms and 13 (12%) had values exceeding 500 ms. With the commonly used Bazett rate correction formula, 102 patients (90%) had QTc greater than 470 ms, including 74 (65%) above 500 ms. By using alternative rate correction formulas, only 24% to 32% of patients had rate-corrected QT intervals above 500 ms. CONCLUSION:QT interval prolongation is common with ATO treatment, but clinically significant arrhythmias are rare and can be avoided with appropriate precautions. Use of the Bazett correction may result in unnecessary interruptions in ATO therapy, and alternative rate correction formulas should be considered for routine electrocardiographic monitoring.
Authors: Miguel A Sanz; Pierre Fenaux; Martin S Tallman; Elihu H Estey; Bob Löwenberg; Tomoki Naoe; Eva Lengfelder; Hartmut Döhner; Alan K Burnett; Sai-Juan Chen; Vikram Mathews; Harry Iland; Eduardo Rego; Hagop Kantarjian; Lionel Adès; Giuseppe Avvisati; Pau Montesinos; Uwe Platzbecker; Farhad Ravandi; Nigel H Russell; Francesco Lo-Coco Journal: Blood Date: 2019-02-25 Impact factor: 22.113
Authors: Matthew A Kutny; Todd A Alonzo; Robert B Gerbing; Yi-Cheng Wang; Susana C Raimondi; Betsy A Hirsch; Cecilia H Fu; Soheil Meshinchi; Alan S Gamis; James H Feusner; John J Gregory Journal: J Clin Oncol Date: 2017-08-02 Impact factor: 44.544