Cytarabine (Arabinofuranosyl Cytidine, ARA-C, Cytosine Arabinoside, Cytosar-U)

Indications

  • Acute Myeloid Leukemia (AML) (see Acute Myeloid Leukemia, [[Acute Myeloid Leukemia]]): prior to bone marrow transplant
  • Non-Hodgkin’s Lymphoma (see Lymphoma, [[Lymphoma]])

Pharmacology

  • Pyrimidine Analog Which Impairs DNA Synthesis: specific for the S-phase of the cell cycle
    • Cytarabine is Rapidly Converted into Cytosine Arabinoside Triphosphate -> Cell Cycle is Held in the S Phase: impairs DNA synthesis
      • This most impacts rapidly dividing cells, which require DNA replication for mitosis
    • Cytarabine Inhibits DNA/RNA Polymerases and Nucleotide Reductase: these enzymes are required for DNA synthesis
  • Inhibits Deoxycytidine Utilization: when used as an anti-viral

Administration

  • IV

Dose Adjustment

  • Hepatic
  • Renal

Adverse Effects

Gastrointestinal Adverse Effects

  • Acute Pancreatitis (see Acute Pancreatitis, [[Acute Pancreatitis]]): questionable association

Neurologic Adverse Effects

Pulmonary Adverse Effects

Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])

  • Epidemiology: associated with intensive regimens
  • Clinical
    • Timing of Onset
      • 13-28% developed their lung injury during ARA-C administration
      • 50% developed lung injury during within a month of completing ARA-C administration
  • Treatment: supportive
  • Prognosis: may be fatal

Other Adverse Effects

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References

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