II. Indications

  1. FDA Approved (combination protocols)
    1. Acute Myelogenous Leukemia
    2. Prostate Cancer (Hormone refractory, symptomatic)
    3. Multiple Sclerosis (progressive, relapsing)
  2. Off-Label
    1. Breast Cancer
    2. Lymphoma (Hodgkin Lymphoma, Non-Hodgkin Lympoma)
    3. Autologous Hematopoietic Stem Cell Transplant (conditioning)

III. Mechanism

  1. See Antibiotic Chemotherapy
  2. Mitoxantrone is a anthracenedione antibiotic with antineoplastic activity
    1. Doxorubicin Analog
  3. Mitoxantrone inserts into and crosslinks DNA
    1. Inhibits DNA and RNA replication
  4. Mitoxantrone binds topoisomerase 2
    1. Results in DNA strand breaks
    2. Inhibits DNA repair

IV. Medications

  1. Mitoxantrone Injection Solution: 20, 25 and 30 mg vials

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Adverse Effects

  1. Severe skin and soft tissue necrosis on extravasation
    1. Mitoxantrone is a strong Vesicant (causes Blistering)
  2. Carcinogenic
    1. Risk of secondary malignancy (esp. )
  3. Cardiotoxicity
    1. Less cardiotoxic than Doxorubicin
  4. Myelosuppression
  5. Hyperuricemia
  6. Hepatotoxicity (increased Liver Function Tests)
  7. Urine Discoloration (transient blue-green coloration)
    1. May also transiently discolor the Sclera

VII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Liver Function Tests
    3. Serum Uric Acid
    4. Echocardiogram with ejection fraction (baseline and prior to each dose)

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