Clofarabine is a chemotherapy agent used primarily in the treatment of relapsed or refractory leukemias. It is FDA-approved for pediatric Acute Lymphoblastic Leukemia (ALL) in patients who have failed at least two prior regimens.
In clinical practice, it is used in several specific combinations:
- For B-cell ALL: It is used in the CLOVE regimen, which combines clofarabine with cyclophosphamide and etoposide.
- For AML: It is employed in the G-CLAC protocol alongside cytarabine and filgrastim.
- Synergy: When combined with cytarabine, the timing of administration is critical due to a theoretical efficacy advantage based on their mechanisms of action.
Averse Effects
- Myelosuppression – neutropenia, anemia, thrombocytopenia
- Infections – bacterial, viral, fungal (high risk)
- Hepatotoxicity – transaminitis, veno-occlusive disease (VOD)
- Capillary leak syndrome – hypotension, edema, pulmonary issues
- Tumor lysis syndrome
- Rash, nausea, mucositis, fever
Monitoring
- CBC with differential (daily during and post-infusion)
- Renal and hepatic function before/during treatment
- Fluid status and blood pressure (capillary leak)
- TLS labs (uric acid, potassium, phosphorus, calcium, creatinine)
- Monitor for signs of infection or VOD
Supportive Measures
- Hydration, allopurinol or rasburicase for TLS prophylaxis
- Anti-infective prophylaxis often needed
- Use caution in hepatic dysfunction or prior HSCT (VOD risk)
Other Notes
- Structurally related to fludarabine and cladribine
- Often used in combination regimens for relapsed/refractory AML or ALL
- Limited use in adults due to toxicity and newer agents
Synonyms
Clolar