Clofarabine is a chemotherapy drug usually given to treat children with acute lymphoblastic leukaemia (ALL) that has come back (relapsed) after initial treatment. This information has been written for the parents or guardians of children with relapsed ALL.
This information should ideally be read with our general information about chemotherapy and your child's type of cancer or leukaemia.
Your child's hospital doctor will see them regularly while they have this treatment so they can monitor the effects of the chemotherapy.
What clofarabine looks like
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Clofarabine is a colourless fluid.
Clofarabine is given as a drip (infusion) that usually takes about two hours. It's given in one of the following ways:
through a fine tube inserted into a vein, usually in the back of the hand (cannula)
through a fine, plastic tube inserted under the skin and into a vein near the collarbone (central line)
into a fine tube inserted into a vein in the crook of the arm (PICC line)
into a small port placed under the skin below the collarbone (Implantable ports).
Your doctor or specialist nurse will explain more about this to you. Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. Clofarabine is usually given every day for five days, and repeated every 2-6 weeks. The nurse or doctor will discuss your treatment plan with you and your child.
Before your child begins treatment, their doctor will arrange for them to have blood tests. They will usually be given anti-sickness drugs before and/or during their treatment.
Each child’s reaction to chemotherapy is different. Some children have very few side effects while others may experience more. The side effects described here won't affect every child who has clofarabine and may be different if more than one type of chemotherapy drug is given at the same time.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect your child. If you notice any effects that are not listed below, discuss them with your doctor or nurse.
Feeling sick (nausea) or being sick (vomiting)
Your child may begin to feel sick a couple of hours after the treatment is given, but this does not usually last long. The doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled or continues, tell the doctor; they can prescribe other anti-sickness drugs that may work better. Some anti-sickness drugs can cause constipation. Let your child's doctor or nurse know if this is a problem.
Risk of infection
Clofarabine can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia can happen from the start of treatment, and their resistance to infection may remain low for up to four weeks after the chemotherapy. Your child's immune system may not recover completely for many months after the treatment has finished. The leukaemia itself can also make your child more prone to infection.
Contact the doctor or the hospital straight away if:
your child's temperature goes above 38ºC (100.4ºF)
your child suddenly feels unwell, even with a normal temperature.
Your child will have regular blood tests to check the number of white blood cells in their blood. Occasionally, it may be necessary to delay treatment if the number of their blood cells (blood count) is still low.
Bruising and bleeding
Clofarabine can reduce the production of platelets, which help the blood to clot. Tell your doctor if your child has any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. Your child may need to have a platelet transfusion if their platelet count is low.
Clofarabine can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make your child feel tired and breathless. Tell your doctor or nurse if your child has these symptoms. They may need to have a blood transfusion if the number of red blood cells becomes too low.
Your child's doctor or nurse can give painkillers to relieve this.
Anxiety and restlessness
Clofarabine can cause anxiety and restlessness in your child. Let your child’s doctor know if any of these symptoms occur.
Clofarabine can cause diarrhoea. This can usually be easily controlled with medicine, but tell your child’s doctor if it's severe or continues. It's important that your child drinks plenty of fluids if they have diarrhoea.
Loss of appetite
Some children lose their appetite while having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask for your child to be seen by a dietitian or specialist nurse at the hospital. They can give advice on how your child can improve their appetite and keeping to a healthy weight. You might find our section on eating well useful.
Tiredness and a general feeling of weakness
Your child may feel very tired. It’s important to make sure they get plenty of rest.
Less common side effects
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Raised levels of uric acid in the blood
Clofarabine can kill the leukaemia cells quickly, and this can lead to an increase in the amount of uric acid in the body. Your child may be given a drug called allopurinol (Zyloric®) to stop this happening. It may also help if they drink plenty of fluids, and they may be given infusions (drips) of fluid during the chemotherapy. While taking clofarabine, uric acid levels will be checked regularly by blood tests.
Clofarabine may cause changes in the way your child's liver works, although this will return to normal when the treatment is finished. These changes are very unlikely to cause any harm. Samples of blood will be taken from time to time to check your child's liver is working properly.
Soreness and redness of the palms of the hands and soles of the feet
This is sometimes known as palmar plantar or hand-foot syndrome. It can happen when clofarabine is given. It is usually temporary and improves when the treatment is finished.
Your child’s doctor may prescribe creams, or a vitamin called pyridoxine (vitamin B6), which some people find helpful. It can also help to keep your child’s hands and feet cool and to avoid tight-fitting clothing, such as socks, shoes and gloves.
The kidneys may be affected
This is unlikely to cause any symptoms. Your child's doctor may check how well their kidneys are working using blood or urine tests.
Acute inflammatory response
Clofarabine can sometimes cause leaking from tiny blood vessels (capillaries). This is a rare side effect that can cause a high temperature, weight gain, breathlessness, a rapid heart rate, dizziness (light-headedness) or fainting. Your child will be closely monitored while they have clofarabine but tell your child’s doctor or nurse immediately if your child has some or any of these symptoms.
Sore mouth and ulcers
Your child's mouth may become sore and they may develop small ulcers. Drinking plenty of fluids, and cleaning their teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some children may find sucking on ice soothing. Tell the nurse or doctor if any of these problems occur, as they can prescribe mouthwashes and medicines to prevent or clear mouth infections. You may find our section on mouth care during chemotherapy helpful
Your child may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at the hospital can give your child advice about ways of coping with this side effect.
It’s important to let your child's doctor know straight away if your child feels unwell or has any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your child’s doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or a chemist, can be harmful to take when having chemotherapy. Tell your child's doctor about any medicines they are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your child’s ability to become pregnant or father a child in the future may be affected by having clofarabine. It's important to discuss fertility with the doctor before they start treatment.
It’s not advisable to become pregnant or father a child while having clofarabine as it may harm the developing baby. It’s important for sexually active young people to use effective contraception while taking this drug and for at least a few months afterwards. Young people can discuss this with their doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect their partner, it’s therefore safest for sexually active young people to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There's a potential risk that chemotherapy drugs may be present in breast milk. Young mothers are advised not to breastfeed during chemotherapy and for a few months afterwards.
If your child is admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after them that they're having chemotherapy treatment. You should tell them the name of your child’s cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if your child has any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based on our Clofarabine factsheet which has been compiled using information from a number of reliable sources, including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.