• Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. If infection occurs delay therapy until resolved. Anemia may occur. Monitor for increased fatigue, dyspnea, and orthostatic hypotension.

Lab Test Considerations:

• Verify negative pregnancy test before starting therapy.Monitor CBC prior to each dosing cycle and periodically as needed. May cause neutropenia, thrombocytopenia, and anemia; occur more frequently in 1st or 2nd treatment cycles. Use early institution of growth factors and antimicrobial agents to prevent infections.
  • If hematologic recovery (ANC ≥1,000 cells/mm³ and platelets ≥50,000 cells/mm³) from previous treatment cycle requires more >6, but <8 wk, delay dosing for up to 2 wk and temporarily reduce dose to 11 mg/m² (33 mg/m²/day, 99 mg/m²/cycle) upon restarting therapy.
  • If hematologic recovery requires >8, but <10 wk, assess for disease progression (by bone marrow aspirates); in the absence of progression, delay dose for up to 2 more wk and reduce dose as above upon restarting, then maintain or increase in subsequent cycles as clinically indicated.
  • Obtain liver function tests and serum creatinine prior to initiation of treatment. May cause hyperbilirubinemia and hypoalbuminemia. If ALT or total bilirubin ≥2 times upper limit of normal, delay therapy until return to normal.
  • Obtain serum creatinine before starting therapy. If serum creatinine ≥2 mg/dL, delay therapy until return to normal.
  • May cause hyperglycemia, hypomagnesemia, hyponatremia, hypokalemia, and hyperkalemia.