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Home > LEU APL - arsenic trioxide, tretinoin and prEDNISone induction followed by consolidation [standard risk] > LEU - arsenic trioxide, tretinoin and prEDNISone induction [standard risk]
This regimen is a component of LEU APL - arsenic trioxide, tretinoin and prEDNISone induction followed by consolidation [standard risk]

arsenic trioxide, tretinoin and prEDNISone [standard risk] - Induction (LEU APL - arsenic trioxide, tretinoin and prEDNISone induction followed by consolidation [standard risk])

Treatment Overview

Differentiation syndrome:

  • Monitor closely for differentiation syndrome in the first 7 to 10 days of treatment.
  • Prompt recognition and treatment with high dose intravenous corticosteroids is necessary until 3 days or longer after complete resolution of symptoms.
  • Decision to withhold tretinoin and arsenic trioxide should be only for severe cases or if lack of response to corticosteroid.

If leucocytosis develops with a white cell count above 10 x 109/L consider administering hydroxycarbamide.

Cycle 1 - 60 days

Cycle length:
60

prEDNISone: Continue for a minimum of 21 days, or until the white cell count (WCC) peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.


tretinoin:

  • Consider dose reduction of tretinoin to 25 mg/m2 daily in TWO divided doses in patients under 20 years of age to reduce risk of pseudotumour cerebri.
  • Teratogenic—Ensure pregnant women are not exposed to tretinoin. Consult prescribing information.

arsenic trioxide:

  • May prolong QTc interval and close monitoring is recommended. Avoid or reduce risk factors for QTc prolongation.
  • Azole antifungals may increase QTc interval. Consult prescribing information.

Cycle details

Cycle 1 - 60 days

Medication Dose Route Days Max Duration
prEDNISone 0.5 mg/kg Once daily oral administration 1 to 21
tretinoin 45 mg/m² Daily in divided doses oral administration 1 to 60
arsenic trioxide 0.15 mg/kg Once daily intravenous 1 to 60 120 minutes

prEDNISone: Continue for a minimum of 21 days, or until the white cell count (WCC) peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.


tretinoin:

  • Consider dose reduction of tretinoin to 25 mg/m2 daily in TWO divided doses in patients under 20 years of age to reduce risk of pseudotumour cerebri.
  • Teratogenic—Ensure pregnant women are not exposed to tretinoin. Consult prescribing information.

arsenic trioxide:

  • May prolong QTc interval and close monitoring is recommended. Avoid or reduce risk factors for QTc prolongation.
  • Azole antifungals may increase QTc interval. Consult prescribing information.

Full details

Cycle 1 - 60 days

Day: 1

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 2

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 3

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 4

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 5

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 6

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 7

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 8

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 9

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 10

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 11

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 12

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 13

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 14

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 15

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 16

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 17

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 18

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 19

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 20

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 21

Medication Dose Route Max duration Details
prEDNISone 0.5 mg/kg Once daily oral administration
Instructions:
  • Take in the morning with food.
  • Continue for a minimum of 21 days or until the WCC peak is reached and then falls or if it is substituted with dexamethasone should differentiation syndrome develop.
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 22

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 23

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 24

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 25

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 26

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 27

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 28

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 29

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 30

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 31

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 32

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 33

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 34

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 35

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 36

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 37

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 38

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 39

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 40

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 41

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 42

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 43

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 44

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 45

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 46

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 47

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 48

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 49

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 50

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 51

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 52

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 53

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 54

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 55

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 56

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 57

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 58

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 59

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Day: 60

Medication Dose Route Max duration Details
tretinoin 45 mg/m² Daily in divided doses oral administration
Instructions:

Daily in TWO divided doses.

  • Take with food. Swallow whole do not crush or chew.
  • Consider dose reduction to 25 mg/m2 daily in patients under 20 years.
  • Round dose to closest multiple of 10 mg capsules.
Additional details:
arsenic trioxide 0.15 mg/kg Once daily intravenous 120 minutes

Additional details

Section 1: Teratogenic effects

Ensure pregnant women are not exposed to tretinoin. Consult prescribing information.

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Routine antifungal prophylaxis recommended
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Emetogenicity: Variable
Gastroprotection: Gastroprotection may be considered
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis may be considered
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis is recommended

Antifungal prophylaxis: Azole antifungals may increase QTc interval. Consult prescribing information.


Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.


Emetogenicity: LOW (IV); MINIMAL to LOW (oral).

References

Phebra NZ Limited Phenasen® New Zealand data sheet 23 July 2019 https://www.medsafe.govt.nz/profs/datasheet/p/phenaseninj.pdf (accessed 15 July 2022).

Pharmaco (NZ) Ltd Vesanoid® New Zealand data sheet 21 April 2022 https://www.medsafe.govt.nz/profs/datasheet/v/Vesanoidcap.pdf (accessed 15 July 2022).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.