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How it is administered
Clofarabine is given as an intravenous (IV) infusion. The recommended pediatric dose is 52 mg/m², administered over 2 hours once daily for 5 consecutive days. This cycle is typically repeated every 2 to 6 weeks, depending on the patient's recovery and organ function. The dose is calculated based on the patient's body surface area (BSA), which is determined by their height and weight. Clofarabine is supplied as a clear, colorless solution in a single-dose vial and must be diluted before administration.
Supportive care, such as IV fluids, medications to prevent nausea, and treatments to manage uric acid levels, is often provided during the 5 days of administration to reduce the risk of certain side effects.
How it works
Clofarabine is a type of chemotherapy known as a purine nucleoside metabolic inhibitor. Once inside the body, clofarabine is converted into its active form within cells. It works by interfering with the DNA synthesis process in rapidly dividing cells, such as leukemia cells. Clofarabine blocks the action of enzymes needed to make new DNA, which is essential for cell growth and division.
By disrupting DNA synthesis and repair, clofarabine causes cancer cells to stop growing and eventually die. It also affects the mitochondria (the energy centers of cells), leading to the release of proteins that trigger programmed cell death (apoptosis). This dual action makes clofarabine effective in killing both actively dividing and resting leukemia cells.
Common side effects
- Vomiting
- Nausea
- Diarrhea
- Febrile neutropenia (fever with low white blood cell count)
- Pruritus (itching)
- Headache
- Bacteremia (bacterial infection in the blood)
- Fever (pyrexia)
- Rash
- Fast heartbeat (tachycardia)
- Abdominal pain
- Chills
- Fatigue
- Loss of appetite (anorexia)
- Pain in extremity
- Low blood pressure (hypotension)
- Nosebleeds (epistaxis)
- Small red or purple spots on the skin (petechiae)
Other serious side effects can include myelosuppression (low blood counts), severe infections, liver and kidney problems, hemorrhage, tumor lysis syndrome, and severe skin reactions such as Stevens-Johnson syndrome.
Who Should take it
Clofarabine is specifically indicated for pediatric patients (ages 1 to 21 years) with acute lymphoblastic leukemia (ALL) that has relapsed or is refractory (not responding) after at least two prior treatment regimens. It is used when other standard treatments have not been successful, offering another option for children and young adults with difficult-to-treat ALL.
Clofarabine may also be considered for patients with relapsed or refractory acute myelogenous leukemia (AML), but its primary FDA-approved use is for ALL in the pediatric population. The decision to use clofarabine is made by the treating oncologist based on the patient's treatment history, overall health, and response to previous therapies.
Who should not take it
There are no absolute contraindications listed for clofarabine, but it should be used with caution in certain situations. Patients who have experienced severe allergic reactions to clofarabine or any of its components should not receive the medication.
Clofarabine should be used with caution in patients with significant liver or kidney impairment, as these conditions can increase the risk of serious side effects. It is also not recommended for use during pregnancy or breastfeeding due to the risk of harm to the fetus or infant. Patients with ongoing severe infections, uncontrolled bleeding, or severe organ dysfunction may not be suitable candidates for clofarabine therapy.
Commonly used with
Clofarabine may be used alone or in combination with other chemotherapy agents, especially in clinical trials or specialized treatment protocols. In some studies, it has been combined with drugs like cyclophosphamide and etoposide, particularly in patients who have previously undergone stem cell transplantation or have relapsed/refractory disease.
Supportive medications, such as antiemetics (for nausea), antibiotics (to prevent or treat infections), and medications to manage uric acid levels, are commonly used alongside clofarabine.
Commonly tested with
Clofarabine has been tested in combination with other chemotherapy agents, such as cyclophosphamide and etoposide, in clinical studies for relapsed or refractory acute leukemia. These combinations are often used in research settings to determine if they improve outcomes compared to single-agent therapy.
Patients receiving clofarabine are also closely monitored with regular blood tests to check blood cell counts, liver and kidney function, and for signs of infection or other complications.
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