Adult Dosing
AML
Remission induction
- 100 mg/m2/day IV as continuous infusion x 7 days
- Alt: 100 mg/m2/day IV q12 hrs x 7 days
ALL
Remission induction
- 100-200 mg/m2/day or 2-6 mg/kg/day as a continuous IV infusion over 24 hrs or in divided doses by rapid injection for 5-10 days
- Repeat courses q2 weeks
Maintenance therapy
- 1 mg/kg/dose SC 1-2 times/wk
- Alt: 70-200 mg/m2 IV for 2-5 days repeated every month
Acute nonlymphocytic leukemia (combination with other chemotherapeutic agents)
- 100 mg/m2 continuous IV on days 1 through 7 or 100 mg/m2 IV q12 hrs for 7 days
- ALT: 10 mg/m2 SC bid for 7-14 days in combination with other chemotherapeutic agents
Refractory acute leukemias
- 2-3 g/m2 IV q12 hrs for 2-6 days
Meningeal leukemia
- 30 mg/m2 IT q4 days
- ALT: 5-75 mg/m2 IT q1-4 days
- Note: Dose varies with the type of CNS symptoms and previous therapy
Acute promyelocytic leukemia [Non-FDA Approved]
- For induction therapy with ATRA (tretinoin) and daunorubicin
- For consolidation-2 x cycles:
- 200mg/m2 IV for 7 days
- 1g/m2 IV q12h x 8 doses
- Note: 2g/m2 q12h x 8 doses-has been used in higher risk patients
Pediatric Dosing
AML
Remission induction
- 100 mg/m2/day IV as continuous infusion x 7 days
- Alt: 100 mg/m2/day IV q12 hrs x 7 days
ALL
Remission induction
- 100-200 mg/m2/day as a continuous IV infusion over 24 hrs or in divided doses by rapid injection for 5-10 days
- Repeat courses q2 weeks
Maintenance therapy
- 1.5 mg/kg/dose SC/IM q1-4 wks
Acute nonlymphocytic leukemia (combination with other chemotherapeutic agents)
- 100 mg/m2 continuous IV on days 1 through 7 or 100 mg/m2 IV q12 hrs for 7 days
Refractory acute leukemias
- 1-3 g/m2 IV q12 hrs for 2-6 days
Meningeal leukemia
- 30 mg/m2 IT q4 days
- ALT: 5-75 mg/m2 IT q1-4 days
- Note: Dose varies with the type of CNS symptoms and previous therapy
Acute promyelocytic leukemia [Non-FDA Approved]
- Usage is still controversial but above doses have been used in children <18 in some trials
- Cytarabine is a potent bone marrow suppressant. Use cautiously in patients with pre-existing drug-induced bone marrow suppression. During induction therapy, perform leukocyte and platelet counts daily. Perform bone marrow examinations frequently after blasts have disappeared from the peripheral blood
- Discontinue or modify therapy when drug-induced marrow depression results in a platelet count < 50,000/mm3, or a polymorphonuclear granulocyte count < 1,000/mm3,
- One case of anaphylaxis has occurred resulting in acute cardiopulmonary arrest which required resuscitation. This occurred immediately after IV administration
- Severe and at times fatal CNS, GI and pulmonary toxicity has been reported. Patients with renal or hepatic function impairment may have a higher likelihood of CNS toxicity after high-dose
- Cases of cardiomyopathy with subsequent death have been reported following experimental high dose therapy with cytarabine in combination with cyclophosphamide
- Cytarabine can cause fetal harm when administered to a pregnant woman. Women of childbearing potential should be advised to avoid becoming pregnant
- Monitor patients receiving high doses for neurotoxicity dysfunction
- Monitor CBC with differential counts qd
- Monitor BUN/creatinine, LFTs, bone marrow exams and serum uric acids frequently
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Concurrent neurotoxic drugs
- Concurrent cytotoxic drugs
- Myelosuppression
- Decreased bone marrow reserve
- Chronic debilitating illnesses
- Women with childbearing potential
Pregnancy Category:D
Breastfeeding: Safety unknown. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother
