Clofarabine (Specialist drug)

How it works

It is phosphorylated intracellularly to an active triphosphate that inhibits DNA polymerase and ribonucleotide reductase, terminating DNA chain elongation and depleting deoxynucleotide pools, leading to apoptosis.

Prescribing in practice

• Can precipitate tumour lysis syndrome and a systemic inflammatory response/capillary leak syndrome (cytokine release), so adequate hydration, monitoring and prophylaxis against tumour lysis are essential.
• Causes profound, sometimes prolonged, bone marrow suppression and is associated with hepatotoxicity and renal impairment.
• A specialist cytotoxic agent that must be prescribed and administered only under haemato-oncology supervision in line with the SPC and current protocols.

Monitoring

Monitor full blood count, renal and hepatic function, fluid balance and for signs of tumour lysis or systemic inflammatory response throughout treatment.

Counselling the patient

• Report fever, breathlessness, swelling, reduced urine output or signs of infection promptly.
• Effective contraception is required during and after treatment because of risks to a pregnancy.
• Treatment is given in a specialist setting with close blood and organ monitoring.

Evidence & guidelines

Use is supported by the SPC and haemato-oncology guidance for relapsed/refractory acute lymphoblastic leukaemia.