Clofarabine (Evoltra) | Cancer Research UK
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What clofarabine is

Clofarabine is a chemotherapy drug. It is pronounced clo-fara-been. It is also called Evoltra.

Clofarabine is a treatment for children and young people up to the age of 21 years with acute lymphoblastic leukaemia. It is used when the leukaemia has come back after at least two other treatments.

Researchers are also looking at it as a treatment for 

  • Older people with acute myeloid leukaemia who can’t have high dose treatment with a stem cell transplant
  • People with myelodysplastic syndrome

How clofarabine works

Clofarabine is a type of chemotherapy drug known as an anti metabolite. Anti metabolites stop cells making DNA, which is the genetic material of the cell. Cancer cells need to make and repair DNA so that they can grow and multiply.


How you have clofarabine

You have it into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.

You can read our information about having chemotherapy into a vein.

You have clofarabine as a drip for 2 hours each day for 5 days. You also have extra fluids through the drip to help stop the build up of uric acid. Uric acid can build up in the body when cancer cells are broken down. After the 5 days of treatment you have a break from treatment of 2 to 6 weeks. This makes up a treatment cycle. Once your level of blood cells goes back to normal you have the next cycle of treatment. The number of cycles of treatment you have depends on your treatment plan and how well the treatment works.

The side effects associated with clofarabine are listed below. You can use the links to find out more about each effect. For general information, see our cancer drug side effects section or use the search box at the top of the page.


Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia)
  • Feeling or being sick affects about 6 out of 10 people (60%) but this is usually well controlled with anti sickness medicines
  • Headaches happen in about 1 out of 4 people (25%)
  • Skin changes occur in 1 out of 5 people (20%) – the changes may include a rash, redness, itching and dryness
  • A high temperature happens in 1 out of 5 people (20%)
  • Diarrhoea affects about 2 out of 10 people – drink plenty of water and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
  • Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (plantar palmar syndrome). This may cause tingling, numbness, pain and dryness
  • Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Mood changes – you may feel anxious and restless
  • Skin flushing
  • A sore mouth
  • Loss of appetite
  • High uric acid levels in your blood due to cancer cells being broken down by the body – you will have regular blood tests and your nurse will ask you to drink plenty of fluids. Your doctors may also give you a drug called allopurinol
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Kidney changes that are unlikely to cause symptoms – the kidneys will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your kidneys are working
  • Pain in your joints, muscles, bone, neck, back and stomach
  • Feeling thirsty and making less urine than usual – drink plenty of water
  • You may have some hearing loss
  • Swelling of your ankles and legs due to a build up of fluid (oedema)
  • Liver changes that are unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment ends. You will have regular blood tests to check how well your liver is working
  • Heart changes which can cause a faster heart beat, and a build up of fluid around the heart. Your doctor will check your heart before and after your treatment
  • Some people have an allergic reaction while having clofarabine treatment, usually during the first or second treatment. Let your treatment team know straight away if you have any skin rashes, itching, or swelling of the lips, face or throat
  • Capillary leak syndrome – a condition where fluid leaks out of the small blood vessels, causing low blood pressure and a build up of fluid. It can become a serious problem. The first symptoms are usually similar to a head cold. Tell your doctor straight away if you feel faint, sick, and have swollen ankles or legs
  • Feeling anxious, irritable or restless
  • Dizziness
  • Shaking (tremor)
  • Hearing problems
  • Blood in vomit, a stomach pain and pain in the bottom. Let your treatment team know straight away if you have this
  • Hair loss
  • Sweating more than usual
  • Blood in your urine – tell your nurse if you have this

Rare side effects

A very small number of people having clofaribine have developed Stevens Johnson syndrome, which is a painful inflammation of the eyes, eyelids and skin. It is not clear whether the Stevens Johnson syndrome is due to the drug.


Important points to remember

You may have a few of the effects mentioned on this page. They may be mild or more severe. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

  • How many times you've had a drug before
  • Your general health
  • How much of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Don't breastfeed during this treatment because the drug may come through in the breast milk.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


Related information


More information about clofarabine

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 25 February 2015