How it is administered

Mitoxantrone is given as an intravenous (IV) infusion. The medication comes as a concentrated solution that must be diluted before use. It is administered slowly into a vein, usually over 5 to 15 minutes, and should only be given by healthcare professionals experienced in chemotherapy. The dose and schedule depend on the condition being treated, but for blood cancers, it is often given in cycles, sometimes in combination with other chemotherapy drugs.

How it works

Mitoxantrone is a type of chemotherapy known as an anthracenedione. It works by interfering with the DNA in cancer cells. Specifically, it binds to DNA and causes crosslinks and breaks in the DNA strands, preventing the cancer cells from dividing and growing. Mitoxantrone also inhibits an enzyme called topoisomerase II, which is essential for DNA repair and replication. This action leads to the death of both rapidly dividing and some non-dividing cancer cells.

In addition to its effects on cancer cells, mitoxantrone can suppress the immune system by inhibiting the proliferation of B cells, T cells, and macrophages. This makes it effective in treating certain autoimmune diseases and blood cancers, but also increases the risk of infections.

Who Should take it

Mitoxantrone is used in combination with other approved drugs for the initial therapy of acute nonlymphocytic leukemia (ANLL) in adults. This includes myelogenous, promyelocytic, monocytic, and erythroid acute leukemias. While it is not specifically approved for T-Cell Prolymphocytic Leukemia (T-PLL), it may be considered as part of a treatment regimen for certain blood cancers if recommended by your oncologist.

Mitoxantrone may also be used in other conditions, such as advanced hormone-refractory prostate cancer (in combination with corticosteroids) and certain types of multiple sclerosis, but its main use in blood cancers is for acute leukemias.

Who should not take it

Mitoxantrone should not be used in patients who have had a previous allergic reaction (hypersensitivity) to it. Patients with pre-existing severe myelosuppression (low blood cell counts due to previous treatments) should not receive mitoxantrone unless the benefits outweigh the risks, as it can further suppress bone marrow function.

Patients with severe liver impairment should not receive mitoxantrone, as the drug is cleared more slowly and can build up to toxic levels. It should not be given to pregnant women, as it can harm the unborn baby. Breastfeeding should also be discontinued before starting treatment, as mitoxantrone passes into breast milk.

Commonly used with

In the treatment of acute nonlymphocytic leukemia, mitoxantrone is commonly used in combination with cytarabine. For other cancers, it may be combined with corticosteroids such as prednisone or hydrocortisone.

It is important to note that mitoxantrone should not be mixed in the same infusion with other drugs unless compatibility is known.

Commonly tested with

Mitoxantrone has been tested in clinical trials in combination with cytarabine for leukemia, and with corticosteroids (prednisone or hydrocortisone) for prostate cancer. In multiple sclerosis, it has been studied with methylprednisolone.

For blood cancers, especially acute leukemias, mitoxantrone plus cytarabine is a standard combination tested in clinical studies.