Clofarabine

INTRODUCTION

Indications

Refractory/relapsed acute lymphoblastic leukemia in children and young people aged 1–21 yr.

Action

Converted intracellularly to the active 5'-triphosphate metabolite which acts as a purine nucleoside antimetabolite; net result is inhibition of DNA synthesis. Produces a rapid reduction of peripheral leukemia cells. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: fatigue. Resp: pharyngitis. CV: pericardial effusion, tachycardia, edema. GI: diarrhea, hepatic toxicity, nausea, abdominal pain, constipation, mucositis, vomiting. F and E: dehydration. Hemat: NEUTROPENIA, anemia, thrombocytopenia. Local: injection site pain. Misc: SYSTEMIC INFLAMMATORY RESPONSE SYNDROME, TUMOR LYSIS SYNDROME, infections, fever, chills.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor neuromuscular signs of electrolyte imbalances that might indicate tumor lysis syndrome. Signs include severe muscle weakness or paralysis due to increased plasma potassium (hyperkalemia) or muscle hyperexcitability and tetany due to phosphate and calcium imbalances (hyperphosphatemia and hypocalcemia). Notify physician immediately if these signs occur.

• Be alert for signs of systemic inflammatory response syndrome. Signs include abnormal body temperature (>38C or <36C), tachycardia (heart rate of >90 bpm) and a respiratory rate of >20 breaths/min. Notify physician immediately; additional diagnostic tests can confirm this syndrome (e.g., a white blood cell count >12,000/|μL or <4000/μL or >10% bands).

• Monitor signs of neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums) or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician immediately.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (see Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

• Because of the risk of tachycardia and pericardial effusion, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Advise patient and family/caregivers about the likelihood of GI reactions (nausea, vomiting, diarrhea, constipation, abdominal pain, irritation of the oral mucosa). Instruct patient to report severe or prolonged GI problems or signs of liver toxicity (yellow skin or eyes, abdominal pain, severe nausea and vomiting, fever, sore throat, malaise, ...