Usual Adult Dose for Hairy Cell Leukemia

0.09 mg/kg/day by continuous IV infusion for 7 days

Alternate dosing recommendation:

• Subcutaneous bolus injection: 0.14 mg/kg/day subcutaneously for 5 consecutive days
• IV infusion: 0.1 mg/kg/day IV for 7 consecutive days
• Under certain hematological conditions (e.g., recovery of severe myelosuppression) a small number of patients may require a second cycle and occasionally a third cycle to achieve a stable and prolonged response.

• Physicians should consider delaying or discontinuing therapy if neurotoxicity or renal toxicity occurs.
• Consult the individual manufacturer product information for dosing recommendations.

Renal Dose Adjustments

Physicians should consider delaying or discontinuing therapy if renal toxicity occurs.

Liver Dose Adjustments

Data not available

Precautions

US BOXED WARNINGS:

• This drug should be administered under the supervision of a qualified physician experienced in the use of antineoplastic therapy.
• Suppression of bone marrow function should be anticipated. This is usually reversible and appears to be dose dependent.
• Serious neurological toxicity (including irreversible paraparesis and quadriparesis) has been reported in patients who received this drug by continuous infusion at high doses (4 to 9 times the recommended dose for Hairy Cell Leukemia). Neurologic toxicity appears to demonstrate a dose relationship; however, severe neurological toxicity has been reported rarely following treatment with standard dosing regimens.
• Acute nephrotoxicity has been observed with high doses of this drug (4 to 9 times the recommended dose for hairy cell leukemia), especially when given concomitantly with other nephrotoxic agents/therapies.

Dialysis

Data not available

Other Comments

General:

• Prior to and during therapy with this drug, prophylaxis against hyperuricemia with allopurinol may be considered.
• Careful monitoring of body temperature, complete blood cell counts, serum electrolytes, BUN, and creatinine concentrations is recommended for at least 4 to 8 weeks.
• Profound bone marrow suppression should be expected within the first 2 weeks of therapy. Red blood cell transfusions and platelet transfusions may be necessary.
• Consideration should be given to delaying or discontinuing therapy if neurotoxicity or renal toxicity occurs.
• The risk of opportunistic infection is significant, particularly in cases of febrile neutropenia.

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