II. Indications
- FDA Approved
- Acute Myelogenous Leukemia (adults and children)
- Acute Lymphocytic Leukemia
- Chronic Myelogenous Leukemia
- Meningeal Leukemia (intrathecal Cytarabine)
- Off-Label
- Central Nervous System Primary Lymphoma
- Chronic Lymphocytic Leukemia
- Hodgkin Lymphoma
- Non-Hodgkin Lymphoma
- Acute Promyelocytic Leukemia (APML)
III. Mechanism
- Pyrimidine Antimetabolite Chemotherapy
- Cytarabine is an analog of cytidine
- Originally discovered in Cryptotethia crypta (sponge species) in the 1950s
- Modified sugar component with arabinose in place of ribose
- Intracellular conversion of Cytarabine to the active triphosphate (araCTP)
- AraCTP is incorporated into DNA
- Results in abnormal DNA rotation that terminates DNA Replication prematurely
- AraCTP also inhibits DNA Polymerase, further blocking replication and repair
IV. Medications
- Cytarabine IV Solution
- Available in 20 mg/ml and 100 mg/ml vials
- Intrathecal depot Cytarabine Liposomal (for Meningeal Leukemia)
- Available in 50 mg/5 ml suspension vials for intrathecal injection
- Minimal systemic effects
- Risk of Chemical Arachnoiditis (see adverse effects below)
- Coadminister with Dexamethasone (see below)
V. Dosing
- See other references for disease specific dosing protocols
VI. Adverse Effects
- Myelosuppression
- Alopecia
- Gastrointestinal
- Hepatotoxicity
- Pancreatitis
- Nausea and Vomiting
- Diarrhea
- Cytarabine Syndrome
- Fever
- Malaise
- Conjunctivitis
- Bone pain and myalgias
- Chest Pain (variably present)
- Maculopapular rash
- Neurologic
- Neurotoxicity
- Peripheral Neuropathy
- Chemical Arachnoiditis (with intrathecal depot Cytarabine Liposomal)
- Presents with Fever, Headache, Nausea and Vomiting
- Coadminister Cytarabine Dexamethasone 4 mg orally or IV twice daily for 5 days
- Mortality risk in untreated patients
VII. Safety
- Avoid in Pregnancy (any trimester)
- Use reliable Contraception
- Avoid in Lactation
- Monitoring
VIII. Resources
- Cytarabine IV Solution (DailyMed)
- Cytarabine (StatPearls)