clofarabine
Clofarabine treats acute lymphoblastic leukemia (ALL) in people ages 1 to 21 years old. It's a chemotherapy medication that works as an antimetabolite to help fight cancer. Clofarabine is used when at least two other cancer treatments haven’t worked. Clofarabine is given as an injection into the vein at a hospital or infusion clinic. It can cause side effects like nausea and low blood counts. Possible risks also include infection and liver problems.
What is Clofarabine?
What is Clofarabine used for?
- Relapsed or refractory acute lymphoblastic leukemia (ALL) in people ages 1 to 21 years old
How Clofarabine works
Clofarabine is a type of chemotherapy medication called an antimetabolite. It looks like one of the building blocks that cells use to make DNA.
This causes the medication to get into the DNA of fast-growing cells, such as cancer cells. It interferes with how these cells make copies of themselves and grow. This damages the cancer cells and causes them to die.
Drug facts
| Common Brands | Clolar |
|---|---|
| Drug Class | Antimetabolite |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
Side effects of Clofarabine
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Low white blood cells (88%)
- Anemia (83%)
- Low platelets (81%)
- Higher liver enzyme levels (up to 81%)
- Vomiting (78%)
- Nausea (73%)
- Diarrhea (56%)
- Febrile neutropenia (55%)
- Higher creatinine levels (50%)
- Headache (43%)
- Itching (43%)
- Fever (39%)
- Rash (38%)
- Fast heartbeat (35%)
- Stomach pain (35%)
- Chills (34%)
- Tiredness (34%)
- Lower appetite (30%)
- Pain in the arm or leg (30%)
- Low blood pressure (29%)
- Nosebleed (27%)
- Petechiae (tiny, red spots on the skin; 26%)
Less Common Side Effects
- Anxiety
- Skin redness or flushing
- Hand-foot syndrome
- Inflammation in the mouth
- Easy bleeding from the gums
- General pain
- Muscle ache
- Back pain
- Bone pain
- Swelling
- Sleepiness
- Weakness
- Irritability
- Shortness of breath
- Blood in urine
- Higher blood pressure
- Infection
Clofarabine serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious infection: temperature of 100.4ºF or higher, with or without other symptoms, like chills, cough, muscle aches, very fast heartbeat, confusion
- Bleeding: frequent nosebleeds, unexplained or easy bleeding or bruising, blood in urine or stool, cough up blood, bleeding that won’t stop, severe headache
- Serious immune or inflammatory reaction: fever, tiredness, headache, muscle or joint pain, rash, trouble breathing, fast breathing, fast or irregular heartbeat, dizziness
- Liver problems: nausea, vomiting, tiredness, stomach pain, swollen stomach, pale stool, dark urine, yellowing of the whites of your eyes or skin
- Serious gut problem: fever, bloody diarrhea, stomach pain or cramping, a swollen belly, nausea, vomiting.
- Serious skin reactions: painful blisters, skin wounds, peeling skin, fever, body aches
The following Clofarabine side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Abdominal or stomach pain or tenderness
area rash
black, tarry stools
bleeding gums
blood in the urine or stools
bloody nose
blurred vision
burning or stinging of the skin
chills
clay-colored stools
confusion
cough or hoarseness
dark urine
decreased urine output
difficult or labored breathing
dilated neck veins
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
facial swelling
fainting
fast, pounding, or irregular heartbeat or pulse
feeling of warmth
flushing, redness of the skin
headache
irregular breathing
itching in the genital area
itching or skin rash
joint pain, stiffness, or swelling
lightheadedness
loss of appetite
lower back or side pain
nervousness
painful cold sores or blisters on the lips, nose, eyes, or genitals
painful or difficult urination
pale skin
pinpoint red spots on the skin
pounding in the ears
rapid, shallow breathing
redness of the face, neck, arms, and occasionally, upper chest
redness, swelling, or skin pain
scaling of the skin on the hands and feet
severe abdominal or stomach cramps with pain
slow or fast heartbeat
small red or purple spots on the skin
sores, ulcers, or white spots on the lips or in the mouth
sweating
swelling of the ankles, feet, or lower legs
swelling or inflammation of the mouth
swollen glands
tenderness
tightness in the chest
tingling of the hands and feet
troubled breathing with exertion
ulcers, sores, or white spots in the mouth
unpleasant breath odor
unusual bleeding or bruising
unusual tiredness or weakness
unusually warm skin
vomiting
vomiting of blood
warmth on the skin
watery and severe diarrhea, which may also be bloody
yellow eyes or skin
Less common
Agitation
blue lips and fingernails
chest pain or discomfort
cloudy urine
coughing that sometimes produces a pink frothy sputum
darkened urine
decrease or increase in the amount of urine
decreased level of consciousness
difficult, fast, or noisy breathing
general feeling of discomfort or illness
hostility
hyperventilation
increased sweating
indigestion
irritability
muscle aches and pains
muscle twitching
pain or tenderness around the eyes and cheekbones
pains in the stomach, side, or abdomen, possibly radiating to the back
rapid weight gain
restlessness
seizures
shaking
shivering
stuffy or runny nose
swelling of the eyelids, face, lips, or hands
trouble sleeping
Incidence not known
Blistering, peeling, or loosening of the skin
red irritated eyes
red skin lesions, often with a purple center
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Back pain
bone pain
bruises on the skin
cracked lips
difficulty with moving
difficulty with swallowing
discouragement
fear
feeling sad or empty
feeling unusually cold
injection site pain
itching, pain, redness, swelling, tenderness, or warmth on the skin at the injection site
lack or loss of strength
loss of interest or pleasure
muscle pain or stiffness
pain in the limbs
pain in the rectum
right upper stomach pain and fullness
sore mouth or tongue
swollen joints
tiredness
trouble concentrating
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
unusually warm skin
white patches with diaper rash
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Clofarabine
Pros
- Can help treat ALL in children and young adults
- An option when other treatments haven’t worked
- Given in cycles, giving your body time to recover between treatments
Cons
- Must be given as an IV infusion at a hospital or infusion center
- Often causes nausea and vomiting
- Can cause low blood cell counts, putting you at risk of infections and bleeding
Pharmacist tips for Clofarabine
- Write down your clofarabine infusion dates on your calendar. Clofarabine is given once a day for 5 days in a row during each treatment cycle. Your next cycle will usually start 2 to 6 weeks later. The timing depends on how well your body recovers from the side effects of treatment.
- Plan ahead for your clofarabine infusions. Each infusion takes at least 2 hours. But give yourself extra time to check in and get settled. It’s helpful to bring something to do to help pass the time.
- Keep all of your lab appointments for clofarabine. These blood tests help the oncology care team make sure the medication is still safe for you. For example, they’ll check your blood counts, kidneys, and liver, among other lab values. Talk to the oncologist about your lab results.
- Take any anti-nausea medications the oncologist has prescribed as directed at home. This can help manage nausea, a common side effect of clofarabine. Tell your oncology care team if nausea is severe or doesn’t get better.
- Tell the oncology care team if you have diarrhea while taking clofarabine. They might recommend a medication such as loperamide (Imodium A-D). Drink plenty of replenishing fluids to stay hydrated. But get medical help right away if you also have a fever or severe stomach pain. This can be a sign of a serious gut problem.
- In general, it’s a good idea to drink plenty of water during your clofarabine treatment. Staying hydrated can help protect your kidneys from the medication. The oncology care team might also give you extra fluids during each infusion. Wash your hands often and avoid people who are sick. Clofarabine can lower your white blood cell count. This can make it harder for your body to fight infections.
- Check your temperature every day while taking clofarabine. Call the oncology care team right away if it’s 100.4ºF or higher, even if you feel okay. This means you have a fever, which is sometimes the only sign that you’re sick. It’s important to tell the care team so they can help before it gets serious.
- If your teen can become pregnant: Your teen should use effective birth control during treatment and for 6 months after the last clofarabine dose. This medication can harm an unborn baby. Let the oncologist know right away if your teen becomes pregnant during treatment.
- If your teen’s partner can become pregnant: Your teen should use birth control like condoms during treatment and for 3 months after their last dose of clofarabine. Tell the oncologist right away if your teen’s partner becomes pregnant.
- If your teen has had a baby and is thinking about breastfeeding: Don’t breastfeed while taking clofarabine and for 2 weeks after the last dose. It’s not known if the medication passes into breast milk, but it could harm a baby. Talk to a lactation consultant about safer feeding options.
- If your teen plans to have children in the future: Talk with the prescriber. Clofarabine might affect fertility. The prescriber can discuss ways to help protect fertility.
Risks and warnings for Clofarabine
Clofarabine can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood cell counts
- Risk factors: Higher clofarabine dose
Clofarabine can cause low blood cell counts. This can happen because of your leukemia (the cancer itself can cause this), or it can be from the medication. Low red blood cells can cause anemia and make you feel more tired. Low platelets can cause your body to have problems stopping bleeding. And low white blood cells can make you more likely to get sick.
Your oncologist will check your blood cell counts often with blood tests while you’re taking clofarabine. If your blood cell counts get too low, your oncologist might delay treatment or lower your clofarabine dose. They can also find ways to get your blood cell counts back up and manage your symptoms.
Bleeding
Some people taking clofarabine have had bleeding episodes. This is because the medication can cause low platelet levels. Bleeding can sometimes be serious or fatal, especially if it happens inside the body. Your oncologist will check your platelet levels with blood tests during treatment.
Tell your oncologist if you have frequent nosebleeds or bruise or bleed more easily than usual. Call 911 right away if you have bleeding that won’t stop, blood in your urine or stool, blood when you cough, or a sudden severe headache or stomach pain. These can be signs of serious bleeding.
Risk of infection
People who take clofarabine commonly develop infections. These infections can be caused by bacteria, fungi, or viruses. Sometimes, they can be serious or life-threatening, for example sepsis. You’re at risk for infections while taking clofarabine because the medication can weaken your immune system. This can make your body have a harder time fighting against infections.
Tell your oncology care team right away if you have any signs or symptoms of an infection. Look out for a fever, body aches, chills, or cough. It’s important to get any infections treated quickly to prevent it from becoming serious.
Tumor lysis syndrome
Clofarabine has been linked to a reaction called tumor lysis syndrome (TLS). This happens when many cancer cells are destroyed quickly. It can cause high levels of potassium in the blood, which can lead to serious heart problems. It can also cause high uric acid levels, which if severe can lead to kidney problems.
Your oncologist will monitor you closely for TLS with blood tests while you’re taking clofarabine. They might give you extra fluids or medications such as allopurinol (Zyloprim) to help prevent serious problems from TLS.
Systemic inflammatory response syndrome (SIRS) and capillary leak syndrome
Rarely, clofarabine can sometimes cause a serious immune reaction called cytokine release syndrome (CRS). If not treated quickly, it can lead to widespread inflammation in the body. In severe cases, it can also cause capillary leak syndrome, where fluid leaks out of the blood vessels. This can lead to dangerously low blood pressure and damage to your organs.
Get medical help right away if you have symptoms such as fever, tiredness, headache, muscle or joint pain, or rash. Also get medical care right away if you have trouble breathing, fast breathing, a fast heartbeat, or dizziness. These can be signs of a serious immune reaction to clofarabine.
If this happens, your oncology care team will stop clofarabine while they treat your symptoms, often with corticosteroids. Once you get better, you might be able to restart clofarabine at a lower dose. In other cases, you might need to stop treatment permanently.
Serious liver problems
- Risk factors: Taking other medications that can harm the liver | Previous stem cell transplant
Some people taking clofarabine can have liver problems. This can include having higher liver enzyme levels in the blood, which can be a sign of liver irritation. It can happen within 10 days after receiving clofarabine and often improves within a couple weeks. But in some cases, liver problems can be severe and life-threatening. Because of this, your oncologist will check your liver with blood tests during treatment.
Tell your oncology care team if you’ve had a stem cell transplant before. This is because you can be at risk of a serious liver problem called veno-occlusive disease (VOD). The risk might be higher after receiving clofarabine with other chemotherapy medications. VOD can block blood flow in the liver and cause high bilirubin levels in the blood and other symptoms.
Call your care team right away if you notice yellow skin or eyes, sudden weight gain, swelling in your belly, or pain in the upper right side of your belly. These can be signs of liver problems.
Serious kidney problems
- Risk factors: Infection | Sepsis | Tumor lysis syndrome | Taking other medications that can harm the kidneys
Rarely, some people taking clofarabine have had kidney problems, including kidney failure. You might not notice symptoms at first. Because of this, your oncologist will check your kidneys with blood tests during treatment.
Tell your oncology care team right away if you see blood in your urine, urinate less than usual, or feel weak, confused, or nauseous. These can be signs of kidney problems.
Serious gut problems
Some people taking clofarabine have had serious inflammation or infection in the gut. This can sometimes be life-threatening. You might be at risk if you have a low white blood cell count or if you take clofarabine with other chemotherapy. It’s often happened within 30 days of starting clofarabine.
Tell your oncology care team right away if you have a fever, bloody diarrhea, stomach pain or cramping, a swollen belly, nausea, or vomiting. Getting treatment early can help prevent more serious problems.
Serious skin reactions
Rarely, some people taking clofarabine have had serious skin reactions. They’re called Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). These skin reactions can be life-threatening. Call for medical help right away if you have painful blisters, skin wounds, peeling skin, or fever. These are signs of a serious skin reaction that need immediate medical care.
Harm to an unborn baby
- Risk factors: Pregnancy
Clofarabine can cause harm to an unborn baby. This might include birth defects or pregnancy loss (miscarriage).
If you can become pregnant, use effective birth control while taking clofarabine and for 6 months after your last dose. If you have a partner who can get pregnant, use birth control, like condoms, during treatment and for 3 months after your last dose. Tell your prescriber right away if you or your partner becomes pregnant during treatment.
Clofarabine dosage
Typical dosage for Clofarabine
The oncologist will choose your dose based on your body size or body surface area (BSA). Your BSA is measured in units of m² and it takes into account your height and weight.
The typical dose is 52 mg/m² given as an injection into a vein (IV). It’s given once a day for 5 days every treatment cycle. Each cycle starts every 2 to 6 weeks, depending on how well your body recovers from side effects.
If you have kidney problems, your dose might be lower.
Interactions between Clofarabine and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Varicella Virus Vaccine, Live
- Zoster Vaccine, Live
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Adenovirus Vaccine
- Bacillus of Calmette and Guerin Vaccine, Live
- Cholera Vaccine, Live
- Dengue Tetravalent Vaccine, Live
- Influenza Virus Vaccine, Live
- Poliovirus Vaccine, Live
- Smallpox Vaccine
- Typhoid Vaccine, Live
- Yellow Fever Vaccine
What are alternatives to Clofarabine?
Clofarabine images
