leurocristine

Action

Unknown. Thought to block cell division and interfere with synthesis of nucleic acid. Cell-cycle-phase specific.

Availability

Solution for injection: 1 mg/ml in 1-, 2-, and 5-ml vials

Indications and dosages

➣ Acute leukemia

Adults: 0.4 to 1.4 mg/m² I.V. weekly, not to exceed 2 mg/dose. (Dosages higher than 2 mg may be used depending on patient, physician, protocol, and facility.)

Children weighing more than 10 kg (22 lb): 2 mg/m² I.V. weekly

Children weighing 10 kg (22 lb) or less: 0.05 mg/kg I.V. weekly

Dosage adjustment

• Hepatic impairment

Off-label uses

• Brain, hepatic, ovarian, testicular, and other cancers

• Neuroblastoma

• Kaposi's sarcoma

• Idiopathic thrombocytopenic purpura

Contraindications

• Hypersensitivity to drug

• Demyelinating form of Charcot-Marie-Tooth disease

• Intrathecal use

Precautions

Use cautiously in:

• infections, decreased bone marrow reserve, hepatic impairment, acute uric acid nephropathy, neuromuscular disease, pulmonary dysfunction, other chronic debilitating illnesses

• females of childbearing age

• pregnant or breastfeeding patients (use not recommended).

Administration

Follow facility protocol for handling and preparing chemotherapeutic drugs. Be especially careful to avoid eye contamination.

• Be aware that patient is usually premedicated with antiemetic.

Give by I.V. route only. (Intrathecal injection is fatal.)

• Inject into tubing of running I.V. line, or inject directly into vein over 1 minute.

• Avoid extravasation (may cause tissue necrosis). If extravasation occurs, stop injection, inject hyaluronidase locally, and apply moderate heat.

• Know that drug may be used with other antineoplastics in some diseases.

Adverse reactions

CNS: agitation, insomnia, depression, mental status changes, ascending peripheral neuropathy, transient cortical blindness, seizures, coma

EENT: diplopia

GI: nausea, vomiting, constipation, abdominal cramps, stomatitis, anorexia, paralytic ileus

GU: nocturia, urinary retention, gonadal suppression, oliguria

Hematologic: anemia, leukopenia, thrombocytopenia (mild and brief)

Metabolic: hyperuricemia, syndrome of inappropriate antidiuretic hormone secretion

Respiratory: bronchospasm

Skin: alopecia

Other: tissue necrosis (with extravasation), phlebitis at I.V. site

Interactions

Drug-drug. Asparaginase: decreased hepatic metabolism of vincristine

Live-virus vaccines: decreased antibody response to vaccine, increased risk of adverse reactions

Mitomycin: increased risk of bronchospasm and shortness of breath

Drug-diagnostic tests. Platelets: increased or decreased count

Uric acid: increased level

White blood cells: decreased count (slight leukopenia) 4 days after therapy, resolving within 7 days

Patient monitoring

Assess respiratory status. Drug may cause bronchospasm, especially in patients who previously received mitomycin.

• Monitor blood pressure.

• Evaluate neurologic status. Know that neurotoxicity is a dose-limiting adverse reaction.

• Monitor CBC with platelet count. Watch for signs and symptoms of blood dyscrasias.

• Stay alert for signs and symptoms of infection.

Patient teaching

• Explain drug therapy to patient. Emphasize importance of follow-up laboratory tests.

• Advise patient to promptly report signs and symptoms of infection and to take his temperature daily.

• Urge patient to practice good oral hygiene, to help prevent infected mouth sores.

• Instruct female of childbearing age to avoid pregnancy. Caution her not to breastfeed during therapy.

• Tell patient that hair loss is a common side effect but typically reverses once treatment ends.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.