飲用水中砷已被公認為對人類具有致癌性，並可導致肺癌、膀胱癌、和皮膚癌。過去的研究顯示，砷的攝入與腎臟癌、肝癌、和前列腺癌之間存在正相關的關係。然而，三氧化二砷已被成功用於治療急性前骨髓性白血病。因此，砷可能在實體癌和血液癌的致癌作用中發揮不同的效應。
飲用水中砷的含量與血液癌發病率之間的關係尚未得到充分研究。我們建立了一個台灣全人口的世代，並使用0.05 mg/L為切點，將台灣的319個鄉鎮分為兩個暴露類別。然後，我們將這些數據與台灣癌症登記資料串聯，按性別、暴露類別、和時間區段，計算淋巴瘤和白血病的標準化發生比，並評估標準化發生比從1981-1990到1991-2000、再到2001-2010隨時間變化的趨勢。
我們發現，在淋巴瘤和白血病中，較高濃度的暴露類別在男性和女性都有較低的標準化發生比。就時間趨勢而言，雖然飲用水中砷的暴露量會隨時間而降低，淋巴瘤和白血病的標準化發生比在兩性中均呈現上升趨勢。因此，飲用水中砷的濃度與男性和女性的淋巴瘤和白血病的發病率呈現負相關，研究結果支持砷的致癌性具有雙重作用，對血液癌具有潛在的保護效應。
三氧化二砷結合全反式維甲酸已經成為急性前骨髓性白血病患者的第一線治療藥物；儘管這種方法的治癒率很高，但存活者面臨著罹患第二原發性惡性腫瘤的潛在風險。我們進行了一項統合分析，評估接受含三氧化二砷治療的急性前骨髓性白血病患者發生第二原發性惡性腫瘤的風險，並對以三氧化二砷為基礎的無化學治療與化學治療進行比較。我們從Embase、Ovid MEDLINE、Web of Science、Cochrane Library 和 Scopus資料庫中檢索了截至2022年11月發表的研究，使用隨機效應模型進行統合分析和分組分析，以評估三氧化二砷暴露與第二原發性惡性腫瘤風險之間的關聯。
統合分析共納入12項研究，涵蓋3,169名急性前骨髓性白血病患者。其中，6項研究的治療包括以三氧化二砷為基礎的無化學治療。在12項研究的統合分析中，含三氧化二砷的治療與第二原發性惡性腫瘤風險的相關性沒有達到統計的顯著。然而，在分組分析中，採用完全基於三氧化二砷的無化學治療的風險較低。結果顯示，在急性前骨髓性白血病患者，以三氧化二砷為基礎的無化學治療與化學治療相比，發生第二原發性惡性腫瘤的風險較低。

Arsenic in drinking water has been recognized as carcinogenic to humans and can cause solid cancers of lung, urinary bladder, and skin. Positive associations have also been reported between arsenic ingestion and cancers of kidney, liver, and prostate. Nevertheless, arsenic trioxide has been used successfully in the treatment of acute promyelocytic leukemia. Therefore, arsenic might play different roles in the carcinogenesis of solid cancers and hematologic malignancies.
The relationship between arsenic in drinking water and the incidences of hematologic malignancies has not been fully investigated. We established a cohort of Taiwanese population and assorted 319 townships of Taiwan into two exposure categories using 0.05 mg/L as the cutoff. Then, we linked these data to the Taiwan Cancer Registry and computed standardized incidence ratios of lymphoma and leukemia by sex, exposure category and time period. The trend of changes in the standardized incidence ratios over time was assessed, from 1981–1990 to 1991–2000 and then to 2001–2010.
We found that in both lymphoma and leukemia, the higher exposure category was associated with lower standardized incidence ratios in both men and women. In terms of time trends, the standardized incidence ratios in both lymphoma and leukemia showed increasing trends in both sexes, while exposure to arsenic in drinking water decreased over time. The arsenic level in drinking water was negatively associated with the incidences of lymphoma and leukemia in both men and women. This study supports the dual effects of arsenic on carcinogenesis, with a potential protective effect against hematologic malignancies.
On the other hand, arsenic trioxide combined with all-trans retinoic acid has been the first line treatment for patients with acute promyelocytic leukemia. Despite the high cure rate of this approach, survivors face the potential risk of developing second primary malignancy. We conducted a meta-analysis aimed to assess the risk of second primary malignancy in acute promyelocytic leukemia patients treated by arsenic trioxide-containing regimens, with subgroup comparison between arsenic trioxide-based chemotherapy-free versus chemotherapy-based regimens. We searched studies published until November 2022 from the following electronic databases: Embase, Ovid MEDLINE, Web of Science, Cochrane Library, and Scopus. Meta-analysis and subgroup analyses using random-effects modeling were conducted to examine the associations between exposure of arsenic trioxide and the risk of second primary malignancy.
A total of 12 studies involving 3,169 patients with acute promyelocytic leukemia were included in the meta-analysis. Of these, treatment in 6 studies included an arsenic trioxide-based chemotherapy-free regimens. In the meta-analysis of the 12 studies, the change in the risk of developing second primary malignancy associated with arsenic trioxide-containing regimens did not reach statistical significance. However, in the subgroup analysis, there was a risk reduction after treatment with a completely arsenic trioxide-based chemotherapy-free regimens. The results showed that in patients with acute promyelocytic leukemia who were treated with arsenic trioxide, chemotherapy-free regimens were associated with a lower risk of developing second primary malignancy compared with chemotherapy-based regimens.

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