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How it is administered
Cytarabine is administered by intravenous (IV) infusion or injection, subcutaneous injection, or intrathecal injection (into the spinal fluid, preservative-free preparations only). It is not effective if taken by mouth. The specific method and schedule depend on the treatment plan and the type of leukemia being treated.
Cytarabine is available in various concentrations and vial sizes, and the dose is usually calculated based on body surface area (mg/m²).
How it works
Cytarabine is a type of chemotherapy medication known as an antimetabolite. It works by interfering with the DNA synthesis of rapidly dividing cells, such as cancer cells. Cytarabine is especially effective during the S-phase of the cell cycle, when cells are actively making DNA.
Once inside the body, cytarabine is converted into an active form that blocks the action of DNA polymerase, an enzyme needed for DNA replication. This prevents cancer cells from multiplying and can lead to cell death. Because it targets rapidly dividing cells, it also affects some normal cells, which can lead to side effects.
Common side effects
- Bone marrow suppression (anemia, low white blood cells, low platelets)
- Nausea and vomiting
- Fever
- Rash
- Diarrhea
- Oral and anal inflammation or ulceration
- Bleeding (all sites)
- Thrombophlebitis (inflammation at injection site)
- Hepatic (liver) dysfunction
- Anorexia (loss of appetite)
- Hair loss (alopecia)
- Cytarabine syndrome (fever, muscle and bone pain, rash, malaise, conjunctivitis)
Less frequent but serious side effects include severe infections, central nervous system effects (such as confusion or coma at high doses), and allergic reactions.
Who Should take it
Cytarabine is used in combination with other approved anti-cancer drugs for remission induction in acute non-lymphocytic leukemia (also known as acute myeloid leukemia, AML) in adults and children. It is also useful in treating acute lymphocytic leukemia and the blast phase of chronic myelocytic (myeloid) leukemia (CML).
For patients with blood cancers like CML in blast crisis, cytarabine may be part of intensive chemotherapy regimens to help reduce the number of leukemia cells and bring about remission. It can also be used intrathecally (into the spinal fluid) for the prevention and treatment of leukemia involving the central nervous system.
Who should not take it
Cytarabine should not be used in patients who are hypersensitive (allergic) to the drug. It should be used with extreme caution in patients with pre-existing bone marrow suppression, as it is a potent bone marrow suppressant itself.
People with severe liver or kidney impairment may require dose adjustments or may not be suitable candidates for cytarabine, as these organs are important for processing and eliminating the drug. Pregnant women should avoid cytarabine, as it can cause harm to the developing fetus. Women of childbearing potential should use effective contraception during treatment.
Commonly used with
Cytarabine is most commonly used in combination with other chemotherapy drugs. For blood cancers, especially AML and CML in blast phase, it is often combined with anthracyclines such as daunorubicin or idarubicin. These combinations are standard in induction chemotherapy regimens.
It may also be used with other agents like cyclophosphamide, vincristine, prednisone, and asparaginase, depending on the specific protocol and type of leukemia.
Commonly tested with
Cytarabine is frequently tested in clinical trials in combination with other chemotherapy agents, especially daunorubicin (as in the '7+3' regimen for AML). It is also tested with other drugs such as idarubicin, etoposide, and sometimes targeted therapies or immunotherapies in research settings.
In CML blast crisis, cytarabine may be part of regimens tested with tyrosine kinase inhibitors or other novel agents.
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