Clofarabine is a chemotherapy drug and is also known by its brand name Evoltra.
It 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 clofarabine into your bloodstream (intravenously).
You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
When you have clofarabine
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. Your doctor may prescribe a medicine called allopurinol to lower blood levels of uric acid.
After the 5 days, you have a break from treatment of 2 to 6 weeks. This makes up a treatment cycle. You might have clofarabine with other treatments.
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.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
Common side effects
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased risk of getting an infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
Breathlessness and looking pale
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Bruising, bleeding gums or nosebleeds
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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 petechiae).
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.
Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.
High temperature (fever)
If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.
Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.
Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.
Soreness, redness and peeling on hands and soles of feet
The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.
Moisturise your skin regularly. Your doctor or nurse will tell you what moisturiser to use.
Tiredness and weakness (fatigue)
Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.
Mood changes (such as anxiety)
You might feel more worried or panicky than usual. Talk to your doctor or nurse about this if you do.
Your skin might feel warm and look red.
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
- sore mouth
- high uric acid levels and other substances in your blood - due to the breakdown of cancer cells
- loss of appetite
- kidney changes
- muscle or joint pain
- feeling thirsty (dehydration)
- hearing problems
- fluid build up (oedema)
- liver changes (such as yellowing of the skin or eyes)
- heart changes (such as changes in heart rhythm)
- allergic reaction
- capillary leak syndrome (leaking of fluid and proteins out of the blood vessels into the tissues)
- agitation or restlessness
- shaking (tremor)
- sweating more than usual
- blood in urine
- hair loss or thinning
- blood in vomit, stomach pain or a pain in your bottom - speak to your doctor straight away if you have these symptoms
- numbness or tingling in fingers or toes (peripheral neuropathy)
Other side effects
There isn’t enough information to work out how often these side effects might happen. You might have one or more of them. They include:
- a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening.
- inflammation of the pancreas (pancreatitis)
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Other medicines, foods or drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Pregnancy and contraception
This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Loss of fertility
You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Don’t breastfeed during this treatment because the drug may come through into your breast milk.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.
You can have:
- other vaccines, but they might not give you as much protection as usual
- the flu vaccine (as an injection)
- the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment
Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.