Clofarabine (Clolar ®)
Classification: Antimetabolite (purine analog)
About Clofarabine (Clolar ®)
Clofarabine is a purine nucleoside analog, which inhibits the enzymatic activities of DNA and RNA. Clofarabine inhibits DNA synthesis, which inhibits the growth of new leukemia cells, interferes with the duplication of DNA, which stops leukemia cells from dividing, and disrupts the mitochondrial membrane, which leads to cell death.
How to Take Clofarabine
Clofarabine is given intravenously (directly into a vein). The dose is based on your size. It is typically given over 2 hours, once a day, for 5 consecutive days and then 23 days "off" before the next dose. This 28 day period is called a cycle and is repeated.
You will have lab work drawn to monitor your complete blood count. Patients should avoid any medications that affect the kidneys or liver while taking clofarabine. Make sure to tell your provider about any medications, vitamins or supplements you may be taking.
Possible Side Effects of Clofarabine
There are a number of things you can do to manage the side effects of clofarabine. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bath daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your doctor or nurse before scheduling dental appointments or procedures.
- Ask your doctor or nurse before you, or someone you live with, has any vaccinations.
Low Red Blood Cell Count (Anemia)
Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.
Low Platelet Count (Thrombocytopenia)
Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. It is important to let your doctor or nurse know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.
- Do not use a razor (an electric razor is fine).
- Avoid contact sports and activities that can result in injury or bleeding.
- Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin®, Aleve®, Advil®, etc. as these can all increase the risk of bleeding. Unless your healthcare team tells you otherwise, you may take acetaminophen (Tylenol).
- Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Diarrhea can be a sign of a serious complication called enterocolitis and can lead to serious dehydration. Symptoms of enterocolitis include diarrhea, nausea, vomiting, abdominal pain, fever and chills. Be sure to report any diarrhea to your oncology team.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Systemic Inflammatory Response Syndrome (SIRS) and Capillary Leak Syndrome
In rare cases, clofarabine can cause a cytokine release syndrome, which can cause tachypnea (fast breathing), tachycardia (fast heart rate), low blood pressure, and pulmonary edema (fluid in the lungs, which can make you feel short of breath).
This can lead to capillary leak syndrome, a condition in which blood and components of blood leak out of vessels and into body cavities and muscles. Signs and symptoms of capillary leak syndrome include: a sudden drop in blood pressure, weakness, fatigue, sudden swelling of the arms, legs or other parts of the body, nausea, and lightheadedness. If you are having any of these symptoms notify your infusion nurse or provider immediately.
Some patients will develop a rash, very dry or itchy skin, which can be managed with skin moisturizers and other topical treatments. However, a rare but serious skin reaction called Stevens Johnson Syndrome can occur, which affects the skin and mucous membranes (lining of mouth and nose). It typically starts as a rash or painful blisters and can progress to serious damage to the skin and in some cases, death. It is important that you report any rash to your healthcare providers immediately.
This medication can cause liver toxicity, which your healthcare provider may monitor for using blood tests called liver function tests. Notify your healthcare provider if you notice yellowing of the skin or eyes, your urine appears dark or brown or pain in your abdomen, as these can be signs of liver toxicity.
This medication can affect your kidney function. Your kidney function will be monitored throughout treatment. If you experience swelling of your face or body, or a decrease in the amount of urine you are producing, notify your healthcare team immediately.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.