Our group is worried about giving full dose ATO to newly diagnosed APL patient due to obesity. Her height is 172.7. weight is 181.3 and BSA is 3 and BMI is 60.8. So ATO dose should be 27 mg and we are doing 20 mg. I was just curious what would be your take on it? I hope we are not underdosing and end up getting poor outcome. Being an APL, we are hoping for cure.
Our approach in obese for arsenic is to use an adjusted body weight for dosing. In your patient this would end up being the exact dose you are giving 20 mg. A few reasons why we are comfortable with dose reducing 1. The UK AML cooperative group uses much lower cumulative doses of arsenic in their protocols (twice weekly doses) compared with the APML0406 protocol /lococco and maintain excellent cure rates 2. A colleague of mine studied arsenic dosing in obesity and found if full dose was given AEs were frequent, dose holds were frequent, and patients needed dose reductions to a point where their median total dose was actually only 50% of the original dose. https://pubmed.ncbi.nlm.nih.gov/31294640/
