Page 1015 - Hematology_ Basic Principles and Practice ( PDFDrive )

898 Part VII Hematologic Malignancies

the urine unchanged. Systemic clearance and volume of distribution a small number of patients. Elevations of liver transaminases are seen
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at steady state were estimated to be 28.8 L/hour/m and 172 L/m , and are transient (typically, less than 2 weeks’ duration) and occurred
respectively. within 1 week of clofarabine initiation. Elevations in bilirubin may
also occur.
Preparation and Administration: Clofarabine is supplied in a
20-mL, single-use vial that contains 20 mg of clofarabine in 20 mL Drug Interactions: None described.
of unbuffered normal saline at a concentration of 1 mg/mL. Clofara-
bine should be filtered through a sterile 0.2-µm syringe filter and Therapeutic Indications in Hematology: Clofarabine is effec-
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diluted with 5% dextrose injection, USP, or 0.9% sodium chloride tive in treating ALL. The recommended pediatric dose is 52 mg/m
injection, USP, before IV infusion to a final concentration between administered by IV infusion over 2 hours daily for 5 consecutive days.
0.15 and 0.4 mg/mL. Treatment cycles are repeated after recovery or return to baseline
organ function, approximately every 2–6 weeks. Clofarabine has been
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Toxic Effects: Bone marrow suppression encompassing all cell used in adults at a dosage of 40 mg/m administered by IV infusion
lines causing anemia, leucopenia, thrombocytopenia, and neutrope- over 2 hours daily for 5 consecutive days. Clofarabine has also been
nia occurs in all patients. A capillary leak syndrome, also known as used in combination with cytarabine. Because this drug is excreted
systemic inflammatory response syndrome (SIRS), thought to be related to a major extent by the kidneys, extreme caution should be used in
to cytokine release leading to respiratory distress, hypotension, pleural patients with renal dysfunction.
effusions, pericardial effusions, and multiorgan failure may occur in