Dressel Amanda, Kwari Monica, McGreal Ann M
Leukemia Clinical Research Center, University of Michigan Medical Center, Ann Arbor, USA.
Clin J Oncol Nurs. 2011 Feb;15(1):E13-23. doi: 10.1188/11.CJON.E13-E23.
Despite improvements in treatment, the outcome for some adult patients with acute or chronic leukemias remains poor. Clofarabine, a second-generation purine nucleoside analog, received U.S. Food and Drug Administration approval in 2004 for the treatment of pediatric patients with relapsed or refractory acute lymphocytic leukemia after at least two previous regimens. In addition, clinical studies have shown encouraging safety and efficacy results with clofarabine in the treatment of adult patients with various hematologic malignancies. Although most adult patients with leukemia receive the first course of clofarabine while hospitalized, many can be subsequently treated as outpatients with proper monitoring, support, and education. The most frequent side effects associated with clofarabine are gastrointestinal-related, myelosuppression, hepatotoxicity, renal dysfunction, and anorexia. Careful patient monitoring is essential to ensure early identification and prompt intervention. Younger patients and those of any age with no comorbid health issues, good performance status, and an adequate support network are more likely to tolerate outpatient clofarabine administration. Early identification and proactive pharmacologic and nonpharmacologic interventions may reduce the severity of these toxicities and prevent their progression. Patient education about strategies for prevention and management of symptoms also is essential.
尽管治疗方法有所改进，但一些成年急性或慢性白血病患者的预后仍然很差。氯法拉滨是一种第二代嘌呤核苷类似物，于2004年获得美国食品药品监督管理局批准，用于治疗至少经过两种先前治疗方案后复发或难治的小儿急性淋巴细胞白血病患者。此外，临床研究表明，氯法拉滨在治疗成年各种血液系统恶性肿瘤患者方面显示出令人鼓舞的安全性和有效性结果。虽然大多数成年白血病患者在住院期间接受首个疗程的氯法拉滨治疗，但许多患者随后可在适当的监测、支持和教育下作为门诊患者接受治疗。与氯法拉滨相关的最常见副作用是胃肠道相关反应、骨髓抑制、肝毒性、肾功能不全和厌食。仔细的患者监测对于确保早期识别和及时干预至关重要。较年轻的患者以及任何年龄且无合并健康问题、身体状况良好且有足够支持网络的患者更有可能耐受门诊氯法拉滨给药。早期识别以及积极的药物和非药物干预可能会降低这些毒性的严重程度并防止其进展。对患者进行症状预防和管理策略的教育也至关重要。
