II. Indications

  1. FDA Approved
    1. Acute Lymphoblastic Leukemia (refractory, age <=21 years)
  2. Off-Label Use
    1. Acute Lymphocytic Leukemia (refractory)
    2. Acute Myelogenous Leukemia (refractory)
    3. Langerhans Cell Histiocytosis (children)

III. Mechanism

  1. Antineoplastic agent for Antimetabolite Chemotherapy
  2. Second generation purine Nucleoside analog
  3. Clofarabine triphosphate (an active metabolite) incorporates into DNA
    1. Results in inhibition of synthesis and repair of DNA
  4. Also disrupts mitochondrial function

IV. Medications

  1. IV Solution: 20 mg in 20 ml

V. Dosing

  1. See other references for disease specific dosing protocols
  2. Reduce dosing in moderate renal Impairment

VI. Adverse Effects

  1. Acute Kidney Injury
  2. Hepatitis or hepatic failure
  3. Myelodepression
  4. Myelodysplastic Syndrome
  5. Tumor Lysis Syndrome

VII. Safety

  1. Avoid in Pregnancy (any trimester)
    1. Use reliable Contraception
  2. Avoid in Lactation
  3. Monitoring
    1. Complete Blood Count
    2. Liver Function Tests
    3. Renal Function tests

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