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Background Acute promyelocytic leukemia is caused by a chromosome translocation t(15; 17),which takes up about 5-10%of all leukemia in adults.Arsenic drug(iAsIII)has exhibited a good efficacy to APL patients,especially to relapsed and refractory patients who are resistant to all-trans retinoic acid(ATRA).At present,blood,urine,saliva,hair,and nails have been used as bio-markers to estimate arsenic exposure to human being.However,the feasibility that these arsenic bio-markers are applied in clinical medicine needs to be further evaluated.Objective The main objective was to study the pharmacokinetics of arsenic drug in APL patients by qualifying and quantifying arsenic species in urine,saliva,plasma,hair,and nail samples.Methods Plasma saliva,urine,hair,and nail samples were collected from nine APL patients ongoing arsenic treatment(iAsⅢ).After sample preparation,arsenic speciation analysis was performed using HPLC-ICP-MS.Results Arsenite(iAsⅢ)as initial form of arsenic drug,and its metabolites including dimethylarsinic acid(DMAⅤ),monomethylarsonic acid(MMAⅤ),arsenate(iAsⅤ),were detected in plasma,urine,saliva,and aqueous extract of hair and nails.Thiol-arsenicals and monomethylarsonous acid(MMAⅢ)were also found in urine,saliva,and water extract of hair and nail.Some arsenicals were bound to the protein in plasma of APL patients.The un-metabolized iAsⅢ species is consistently the major species in all bio-markers.The arsenic is easily eliminated from plasma with a half-life of about 1 h.The arsenic levels in urine and saliva timely reflect arsenic administration and metabolism of arsenic drug in APL patients,which was recommended as appropriate biomarkers applied in clinical medicine.By reason of properties and growth periods of hair and nails,the arsenic content in hair and nails indicate arsenic accumulation from previous arsenic infusion long time ago.Conclusion Most of arsenic in all bio-markers is identified as the intact form iAsⅢ,a amount of iAsⅢ is metabolized into iAsV,DMAⅤ,MMAⅤ,MMAⅢ,thiol-arsenicals.The arsenic level in plasma is transitory.Urinary and salivary arsenic can timely indicate ongoing arsenic infusion,suggesting that they are appropriate bio-markers for application of clinical medicine.Past arsenic treatment leads to arsenic accumulation in hair and nail.