{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:21:22Z","timestamp":1789017682001,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T00:00:00Z","timestamp":1704844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Arsenic trioxide is an essential component of therapy for acute promyelocytic leukaemia (APL) and is currently dosed on actual body weight with no upper limit. Arsenic\u2010induced neurotoxicity is a well\u2010recognised complication; however, there is uncertainty about its relationship to arsenic dose and obesity. We conducted a large multicentre retrospective study of 487 patients with APL treated with arsenic\u2010based therapy across 23 sites in Australia from 2008 to 2023. The primary outcome was incidence of neurotoxicity, and secondary outcomes included relationship of neurotoxicity to obesity and cumulative arsenic dose. Any\u2010grade neurotoxicity occurred in 113 (23%) patients, predominantly peripheral neuropathy (91%). Most events were grade 1\u20132 severity (85%), with grade 3 events in 12% and grade 4\u20135 in 3%. The incidence of neurotoxicity increased with BMI (non\u2010obese: 16%, obesity class I: 25%, obesity class II\u2013III: 41%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). On univariable analysis, obesity class I (OR 1.81, <jats:italic>p<\/jats:italic>\u2009=\u20090.036), obesity class II\u2013III (OR 3.93, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), weight &gt;100\u2009kg (OR 2.72, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), daily arsenic trioxide dose &gt;15\u2009mg (OR 5.05, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and cumulative induction dose &gt;500\u2009mg (OR 3.95, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) were all significantly associated with neurotoxicity. Obesity class II\u2013III and induction dose &gt;500\u2009mg remained significant on multivariable analysis. Our study highlights the strong association between BMI, arsenic trioxide dose and neurotoxicity. Pre\u2010emptive dose reductions should be considered for obese patients receiving high doses of arsenic.<\/jats:p>","DOI":"10.1111\/bjh.19297","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T23:34:55Z","timestamp":1704929695000},"page":"1732-1739","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Arsenic\u2010induced neurotoxicity in patients with acute promyelocytic leukaemia"],"prefix":"10.1111","volume":"204","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9215-1441","authenticated-orcid":false,"given":"Zoe","family":"Loh","sequence":"first","affiliation":[{"name":"Department of Clinical Haematology Austin Health  Heidelberg Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ashby","sequence":"additional","affiliation":[{"name":"Department of Clinical Haematology Alfred Health  Melbourne Victoria 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