- Acute non-lymphocytic leukemia
- Relapsed acute lymphocytic leukemia
- Non-Hodgkin's lymphoma
THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.
- Available as a 2 mg/mL solution.
- Store at room temperature
- Drug is dark blue in color
- Diluted solution stable 24 hours at room temperature
- DO NOT freeze
- Solutions Compatible: D5W, 0.9%, combinations
- Additive/Above Cassette Compatible: no information
- Y-site Compatible: allopurinol, cyclophosphamide, cytarabine, fludarabine, hydrocortisone, KCl, ondansetron, teniposide
INCOMPATIBLE: amphotericin B, heparin, piperacillin/tazobactam, propofol, TPN
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct |
NO |
| IV Intermittent Infusion | YES, chemotherapy trained RN only Usual dilution: in 50-100 mL of IV fluid Infusion time: 15 - 60 minutes |
| IV Continuous Infusion | NO |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
- 12 mg/m2 over 2-3 days Q 3 weeks
- Decrease dose by 50% if bilirubin is >50 umol/L
- Children BSA <0.5 m2 should be dosed on a mg/kg basis. To obtain mg/kg dose, divide mg/m2 dose by 30 (ie 1 m2 = 30 kg).
** Dosage may differ according to protocol
Immediate (within minutes to hours):
- Nausea and vomiting (mild to moderate emetogenic potential), diarrhea
- Hypotension - rare, monitor blood pressure
- Transient arrhythmias
- Phlebitis
- Anaphylaxis (very rare) - shortness of breath, swelling of face, eyelids, lips, tightness in chest
- Anorexia
- Non-vesicant - if extravasates, may result in pain or swelling. If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.
Delayed (within days to weeks):
- Myelosuppression (nadir 9 days)
- Cardiotoxicity - CHF, monitor cardiac function (ECG, echocardiogram, MUGA, chest X-ray), see lifetime cumulative dose (below)
- Alopecia
- Mucositis
- May impart blue-green coloration to urine, sclera, tears, sweat for 24 hours after administration
- Transient increases of liver function tests
Late:
- Congestive heart failure, cardiomyopathy, EKG changes and arrhythmias
- Treatment for unusual side effects are available through the study chair identified on the front page of the protocol and/or pharmacy
- Monitor hematologic parameters, BP, hepatic function, renal function, serum electrolytes
- Verify whether cardiac function studies are needed prior to administration
- Cardiotoxicity may be enhanced in patients who have received mediastinal radiotherapy or who have pre-existing cardiac disease or who are receiving high doses of cyclophosphamide (>2 g/m2)
- Mitoxantrone is contraindicated in impaired cardiac function (see protocol specifics)
- Total cumulative lifetime dose in children is 160 mg/m2 which is approximately equivalent to 450 mg/m2 of anthracycline (ie. doxorubicin). (Anthracycline factor is 2.5.)
- If child receives concomitant radiation to the mediastinum (field of the heart), or is receiving high doses of cyclophosphamide the cumulative lifetime dose should be decreased to 120 mg/m2 which is regarded as equivalent to 360 mg/m2 of anthracycline.
- Recall dermatitis may occur in previously irradiated areas