Clofarabine is a substance that is being studied in the treatment
of cancer. It is a purine nucleoside antimetabolite. It is marketed in
the U.S. and Canada as Clolar. In Europe and Australia/New Zealand the
product is marketed under the name Evoltra.

It is used in paediatrics to treat a type of leukaemia called relapsed
or refractory acute lymphoblastic leukaemia (ALL), only after at least
two other types of treatment have failed. It is not known if extends life
expectancy. Some investigations of effectiveness in cases of acute myeloid
leukaemia (AML) and juvenile myelomonocytic leukaemia (JMML) have been
carried out.

Side effects

* Tumor lysis syndrome (TLS). clofarabine quickly kills leukaemia cells
in the blood. The body may react to this. Symptoms include fast breathing,
fast heartbeat, low blood pressure, and fluid in the lungs. TLS is very
serious and can lead to death if it is not treated right away.
* Bone marrow problems (suppression). clofarabine can stop the bone marrow
from making enough red blood cells, white blood cells, and platelets.
Serious side effects that can happen because of bone marrow suppression
include severe infection (sepsis), bleeding, and anemia.
* Effects on pregnancy and breastfeeding. Girls and women should not become
pregnant or breastfeed during treatment which harm the baby.
* Dehydration and low blood pressure. clofarabine can cause vomiting and
diarrhea which may lead to low body fluid (dehydration). Signs and symptoms
of dehydration include dizziness, lightheadedness, fainting spells, or
decreased urination.
* Other side effects. The most common side effects are stomach problems
(including vomiting, diarrhea, and nausea), and effects on blood cells
(including low red blood cells count, low white blood cell count, low
platelet count, fever, and infection. clofarabine can also cause tachycardia
and can affect the liver and kidneys.

Contraindications

* pregnancy or planned pregnancy
* breast-feeding
* liver problems
* kidney problems

Drug interactions

* nephrotoxic drugs
* hepatotoxic drugs

Delivery

* By intravenous infusion.
* Dosage is a 2 hour infusion (52 mg/m²) every day for five days.
The cycle is repeated every 2 to 6 weeks.
* Regular blood tests to monitor his or her blood cells, kidney function,
and liver function.