II. Indications
- FDA Approved (combination protocols)
- Acute Myelogenous Leukemia
- Prostate Cancer (Hormone refractory, symptomatic)
- Multiple Sclerosis (for refractory progressive or relapsing disease)
- Off-Label
- Breast Cancer
- Lymphoma (Hodgkin Lymphoma, Non-Hodgkin Lympoma)
- Autologous Hematopoietic Stem Cell Transplant (conditioning)
III. Mechanism
- See Antibiotic Chemotherapy
- Mitoxantrone is a anthracenedione Antibiotic with antineoplastic activity
- Doxorubicin Analog
- Mitoxantrone inserts into and crosslinks DNA
- Inhibits DNA and RNA replication
- Mitoxantrone binds topoisomerase 2
- Results in DNA strand breaks and inhibits DNA repair
- Inhibits proliferation of B Cells, T Cells and Macrophages
- Inhibits Antigen Presentation
- Decreases Cytokine release
IV. Medications
- Mitoxantrone Injection Solution: 20, 25 and 30 mg vials
V. Dosing
- See other references for disease specific dosing protocols
VI. Adverse Effects
- Severe skin and soft tissue necrosis on extravasation
- Carcinogenic
- Risk of secondary malignancy (esp. )
- Cardiotoxicity
- Cardiomyopathy or Congestive Heart Failure
- Less cardiotoxic than Doxorubicin
- Myelosuppression
- Hyperuricemia
- Hepatotoxicity (increased Liver Function Tests)
-
Urine Discoloration (transient blue-green coloration)
- May also transiently discolor the Sclera
VII. Safety
- Avoid in Lactation
- Avoid in pregnancy (all trimesters)
- Use reliable Contraception
- Monitoring
- Complete Blood Count
- Liver Function Tests
- Serum Uric Acid
- Echocardiogram with ejection fraction (baseline and prior to each dose)
VIII. Resources
- Mitoxantrone Injection Solution (DailyMed)