How it is administered

Mitoxantrone is given as an intravenous (IV) infusion. The medication comes as a concentrate that must be diluted before use. It is administered by a healthcare professional, typically into a vein over a period of at least 3 to 15 minutes. For Acute Myeloid Leukemia (AML), it is used in combination with other chemotherapy drugs and given in cycles as part of induction and consolidation therapy.

How it works

Mitoxantrone is a type of chemotherapy medicine known as an anthracenedione. It works by interfering with the DNA in cancer cells. Specifically, mitoxantrone binds to DNA and causes crosslinks and breaks in the DNA strands, which prevents the cancer cells from dividing and growing. It also inhibits an important enzyme called topoisomerase II, which is responsible for uncoiling and repairing damaged DNA. This action is not specific to any one phase of the cell cycle, meaning it can affect both dividing and resting cells.

In addition to its effects on DNA, mitoxantrone can impair the function of immune cells such as B cells, T cells, and macrophages. This can reduce inflammation and immune responses, which is why it is also used in some autoimmune diseases. However, in the context of blood cancers like AML, its main role is to kill rapidly dividing cancer cells.

Who Should take it

Mitoxantrone is indicated for adults with acute nonlymphocytic leukemia (ANLL), which includes Acute Myeloid Leukemia (AML) and related subtypes such as myelogenous, promyelocytic, monocytic, and erythroid leukemias. It is used in combination with other approved chemotherapy drugs, most commonly cytarabine, as part of the initial treatment (induction therapy) and sometimes for consolidation therapy after remission is achieved.

Mitoxantrone may also be used for other conditions, such as advanced hormone-refractory prostate cancer and certain forms of multiple sclerosis, but its main use in blood cancers is for AML and related diseases.

Who should not take it

Mitoxantrone should not be used in patients who have had a previous allergic reaction or hypersensitivity to mitoxantrone. It should also be avoided in patients with severe liver impairment, as the drug is cleared more slowly and can build up to dangerous levels in the body.

Patients with pre-existing severe bone marrow suppression (low blood counts) from previous chemotherapy should not receive mitoxantrone unless the potential benefit outweighs the risk. It should not be given by routes other than intravenous infusion (such as intrathecal or subcutaneous), as this can cause severe and potentially irreversible nerve damage. Pregnant women should not use mitoxantrone, as it may cause harm to the unborn baby.

Commonly used with

In the treatment of Acute Myeloid Leukemia (AML), mitoxantrone is most commonly used in combination with cytarabine, another chemotherapy drug. This combination is used for both induction (to achieve remission) and consolidation (to maintain remission) therapy.

Mitoxantrone may also be used with corticosteroids in other cancers, but for AML, the main combination is with cytarabine.

Commonly tested with

Mitoxantrone has been tested in combination with cytarabine in large clinical trials for the treatment of AML and other acute nonlymphocytic leukemias. It has also been compared to daunorubicin (another chemotherapy drug) in combination with cytarabine.

In other cancers, mitoxantrone has been tested with corticosteroids such as prednisone or hydrocortisone. However, for blood cancers like AML, the primary combination is with cytarabine.