• Monitor respiratory status and BP during clofabarine infusion.
• Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, and emesis) and avoid IM injections and rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. If a clinically significant infection occurs, withhold therapy until infection is controlled, then restart at full dose. Anemia may occur. Monitor for increased fatigue, dyspnea, and orthostatic hypotension.
• Monitor for signs and symptoms of tumor lysis syndrome and cytokine release (tachypnea, tachycardia, hypotension, pulmonary edema) that could develop into systemic inflammatory response syndrome (SIRS), capillary leak syndrome (pleural and pericardial effusions) and organ dysfunction. Administer continuous IV fluids during 5 days of therapy to reduce effects of tumor lysis syndrome and other adverse drug reactions. Administer prophylactic corticosteroids (hydrocortisone 100 mg/m² of Days 1 and 3) and allopurinol if hyperuricemia is expected. If significant signs or symptoms of SIRS or capillary leak syndrome occur, discontinue clofarabine immediately; diuretics and albumin may be used; may be fatal. Clofarabine may be reinstituted, with a 25% dose reduction, when the patient is stable.
• Assess for nausea and diarrhea. Prevent dehydration. Discontinue clofarabine administration if hypotension occurs during 5 days of therapy. If hypotension resolves without pharmacological intervention, clofarabine may be reinstituted, usually at a lower dose.
• Monitor for signs and symptoms of enterocolitis (abdominal pain, nausea, vomiting, diarrhea), especially during first 30 days of therapy. Treat promptly.

Lab Test Considerations:

• Verify negative pregnancy test before starting therapy.Monitor CBC and platelet counts at regular intervals during therapy and more frequently if levels are abnormal. May cause anemia, leukopenia, thrombocytopenia, neutropenia, febrile neutropenia, and infection. If Grade 4 neutropenia (ANC <0.5 X 10⁹/L) occurs and lasts ≥4 wks, reduce dose by 25% for next cycle.
  • Monitor hepatic and renal function frequently during therapy. May cause ↑ AST, ALT, and bilirubin; usually occur within 1 wk of administration and return to baseline within several days. If bilirubin ↑≥Grade 3, discontinue clofarabine and restart with a 25% dose reduction when stable and organ function returned to baseline.
  • May cause ↑ serum creatinine. If ≥Grade 3 renal toxicity occurs, discontinue clofarabine and restart with a 25% dose reduction when stable and organ function returned to baseline.