(klo FARE a been)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous [preservative free]:
Clolar: 1 mg/mL (20 mL)
Brand Names: U.S.
- Antineoplastic Agent, Antimetabolite
- Antineoplastic Agent, Antimetabolite (Purine Analog)
Clofarabine, a purine (deoxyadenosine) nucleoside analog, is metabolized to clofarabine 5'-triphosphate. Clofarabine 5'-triphosphate decreases cell replication and repair as well as causing cell death. To decrease cell replication and repair, clofarabine 5'-triphosphate competes with deoxyadenosine triphosphate for the enzymes ribonucleotide reductase and DNA polymerase. Cell replication is decreased when clofarabine 5'-triphosphate inhibits ribonucleotide reductase from reacting with deoxyadenosine triphosphate to produce deoxynucleotide triphosphate which is needed for DNA synthesis. Cell replication is also decreased when clofarabine 5'-triphosphate competes with DNA polymerase for incorporation into the DNA chain; when done during the repair process, cell repair is affected. To cause cell death, clofarabine 5'-triphosphate alters the mitochondrial membrane by releasing proteins, an inducing factor and cytochrome C.
Vd: Decreased with increasing age, based on pharmacokinetic simulations: 5.8 L/kg (3 years old); 3.1 L/kg (30 years old); 2.7 L/kg (82 years old) (Bonate 2011); Children and Adolescents 2 to 19 years: 172 L/m2
Intracellulary by deoxycytidine kinase and mono- and diphosphokinases to active metabolite clofarabine 5′-triphosphate; limited hepatic metabolism (0.2%)
Urine (49% to 60%, as unchanged drug)
Children and Adolescents 2 to 19 years: 5.2 hours; Children and Adults: 7 hours; may be prolonged in in the elderly and in patients with renal impairment (Bonate, 2011)
47%, primarily to albumin
Special Populations: Renal Function Impairment
Clofarabine undergoes renal elimination and exposure is increased as creatinine clearance decreases (Bonate 2011). In patients with CrCl 60 to <90 mL/minute, the AUC was increased by 60% and in patients with CrCl 30 to <60 mL/minute, the AUC was increased by 140%.
Use: Labeled Indications
Acute lymphoblastic leukemia: Treatment of relapsed or refractory acute lymphoblastic leukemia (ALL) in patients 1 to 21 years of age (after at least 2 prior regimens)
Treatment of relapsed/refractory acute lymphoblastic leukemia (ALL) in adults; treatment of refractory acute myeloid leukemia (AML) in adults <70 years of age; treatment of refractory Langerhans cell histiocytosis
There are no contraindications listed in the manufacturer’s U.S. labeling.
Canadian labeling: Hypersensitivity to clofarabine or any component of the formulation; symptomatic CNS involvement; history of serious heart, liver, kidney, or pancreas disease; severe hepatic impairment (AST and/or ALT >5 x ULN, and/or bilirubin >3 x ULN); severe renal impairment (CrCl < 30 mL/minute)
Note: Consider prophylactic corticosteroids (hydrocortisone 100 mg/m2 on days 1 to 3) to prevent signs/symptoms of capillary leak syndrome or systemic inflammatory response syndrome (SIRS), and hydration and antihyperuricemic therapy (to reduce the risk of tumor lysis syndrome/hyperuricemia). Calculate body surface area (BSA) prior to each cycle, utilizing actual body weight. Clofarabine is associated with a moderate emetic potential; antiemetics are recommended to prevent nausea and vomiting (Basch, 2011; Dupuis, 2011; Roila, 2010).
Acute lymphoblastic leukemia (ALL), relapsed or refractory: Children ≥1 year, Adolescents, and Adults ≤21 years: IV: 52 mg/m2/day days 1 through 5; repeat every 2 to 6 weeks; subsequent cycles should begin no sooner than 14 days from day 1 of the previous cycle (subsequent cycles may be administered when ANC ≥750/mm3)
Acute lymphoblastic leukemia, relapsed/refractory (ALL; off-label population): Adults: IV:
Induction: 40 mg/m2 once daily for 5 days; may repeat induction cycle once in 3 to 6 weeks if needed (depending on marrow response and recovery) (Kantarjian, 2003)
Consolidation: 30 mg/m2 once daily for 5 days (or last tolerated induction dose, whichever is lower); repeat every 4 weeks for up to a maximum of 6 consolidation cycles (Kantarjian, 2003)
Acute myeloid leukemia (AML), refractory (off-label use): Adults <70 years: IV:
Induction: 25 mg/m2/day for 5 days (in combination with cytarabine and filgrastim); may repeat one time after 21 days if needed (Becker, 2011)
Consolidation: 20 mg/m2/day for 5 days (in combination with cytarabine and filgrastim) for 1 or 2 cycles (Becker, 2011)
Langerhans cell histiocytosis, refractory (off-label use): Children 1 to 18 years: IV: 25 mg/m2/day days 1 through 5; repeat every 28 days for 2 to 8 cycles (Simko, 2014). Additional data may be necessary to further define the role of clofarabine in this condition.
Dosage adjustment for toxicity:
Hematologic toxicity: ANC <500/mm3 lasting ≥4 weeks: Reduce dose by 25% for next cycle
Clinically significant infection: Withhold treatment until infection is under control, then restart at full dose
Grade 3 toxicity (excluding infection, nausea and vomiting, and transient elevations in transaminases and bilirubin): Withhold treatment; may reinitiate with a 25% dose-reduction with resolution or return to baseline
Grade ≥3 increase in creatinine or bilirubin: Discontinue clofarabine; may reinitiate with 25% dosage reduction when creatinine or bilirubin return to baseline and patient is stable; administer antihyperuricemic therapy for elevated uric acid.
Grade 4 toxicity (noninfectious): Discontinue treatment
Capillary leak or SIRS early signs/symptoms (eg, hypotension, tachycardia, tachypnea, pulmonary edema): Discontinue clofarabine; institute supportive measures. May consider reinitiating with a 25% dose reduction after patient is stable and organ function recovers to baseline.
Dermatologic toxicity: Exfoliative or bullous rash, or suspected Stevens-Johnson syndrome or toxic epidermal necrolysis: Discontinue clofarabine.
Hypotension (during the 5 days of administration): Discontinue clofarabine. If hypotension is transient and resolves (without pharmacologic intervention), may reinitiate with 25% dosage reduction (Canadian labeling).
Dosage adjustment in renal impairment: Clofarabine undergoes renal elimination and exposure is increased as creatinine clearance decreases (Bonate, 2011).
Renal impairment at baseline:
CrCl 30 to 60 mL/minute: Reduce dose by 50%
CrCl <30 mL/minute: There are no dosage adjustments provided in the manufacturer’s labeling; use with caution (has not been studied).
CrCl ≥30 mL/minute: There are no dosage adjustments provided in the manufacturer’s labeling; use with caution (has not been studied).
CrCl <30 mL/minute: Use is contraindicated.
Renal toxicity during treatment: Grade 3 or higher increase in serum creatinine: Discontinue clofarabine; may reinitiate with a 25% dose reduction after patient is stable and organ function recovers to baseline.
Dosage adjustment in hepatic impairment:
Hepatic impairment at baseline: There are no dosage adjustments provided in the manufacturer’s labeling; use with caution (has not been studied). Canadian labeling contraindicates use in severe impairment.
Hepatotoxicity during treatment: Grade 3 or higher increase in bilirubin: Discontinue clofarabine; may reinitiate with a 25% dose reduction after patient is stable and organ function recovers to baseline.
Dosing in obesity:
American Society for Blood and Marrow Transplantation (ASBMT) practice guideline committee position statement on chemotherapy dosing in obesity: Utilize actual body weight (full weight) for calculation of body surface area in clofarabine dosing for hematopoietic stem cell transplant conditioning regimens in pediatrics and adults (Bubalo, 2014).
Hazardous agent; use appropriate precautions for handling and disposal (NIOSH 2014 [group 1]). Clofarabine should be diluted with NS or D5W to a final concentration of 0.15 to 0.4 mg/mL. Manufacturer recommends the product be filtered through a 0.2 micron filter prior to dilution.
Clofarabine is associated with a moderate emetic potential; antiemetics are recommended to prevent nausea and vomiting (Basch, 2011; Dupuis, 2011; Roila, 2010).
IV infusion: Infuse over 2 hours for relapsed/refractory ALL. May be infused over 1 hour for some off-label protocols (Becker, 2011; Kantarjian, 2003). Continuous IV fluids are encouraged to decrease adverse events and tumor lysis effects. Hypotension may be a sign of capillary leak syndrome or systemic inflammatory response syndrome (SIRS). Discontinue if the patient becomes hypotensive during administration; may consider therapy reinitiation with a 25% dose reduction after return to baseline. Do not administer any other medications through the same intravenous line.
Hazardous agent; use appropriate precautions for handling and disposal (NIOSH 2014 [group 1]).
Stable in D5W or NS. Do not administer other medications through the same intravenous line.
Store intact vials at room temperature of 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Solutions diluted for infusion in D5W or NS may be stored for 24 hours at room temperature.
Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Consider therapy modification
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Monitor therapy
Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
BCG (Intravesical): Immunosuppressants may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy
Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Monitor therapy
Coccidioides immitis Skin Test: Immunosuppressants may diminish the diagnostic effect of Coccidioides immitis Skin Test. Monitor therapy
Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Avoid combination
Denosumab: May enhance the adverse/toxic effect of Immunosuppressants. Specifically, the risk for serious infections may be increased. Monitor therapy
Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Avoid combination
DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Monitor therapy
Echinacea: May diminish the therapeutic effect of Immunosuppressants. Consider therapy modification
Fingolimod: Immunosuppressants may enhance the immunosuppressive effect of Fingolimod. Management: Avoid the concomitant use of fingolimod and other immunosuppressants when possible. If combined, monitor patients closely for additive immunosuppressant effects (eg, infections). Consider therapy modification
Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy
Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Consider therapy modification
Levodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa. Monitor therapy
Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Avoid combination
Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Consider therapy modification
Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Pimecrolimus: May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Roflumilast: May enhance the immunosuppressive effect of Immunosuppressants. Consider therapy modification
Sipuleucel-T: Immunosuppressants may diminish the therapeutic effect of Sipuleucel-T. Monitor therapy
Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants. Avoid combination
Tofacitinib: Immunosuppressants may enhance the immunosuppressive effect of Tofacitinib. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants. Avoid combination
Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Monitor therapy
Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting an immunosuppressant. If vaccinated during immunosuppressant therapy, revaccinate at least 3 months after immunosuppressant discontinuation. Consider therapy modification
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Avoid combination
Cardiovascular: Tachycardia (35%), hypotension (29%; grade 3: 11%; grade 4: 8%), flushing (19%), hypertension (13%), edema (12%)
Central nervous system: Headache (43%), chills (34%), fatigue (34%), anxiety (21%), pain (15%)
Dermatologic: Pruritus (43%), skin rash (38%), palmar-plantar erythrodysesthesia (16%), erythema (11%)
Gastrointestinal: Vomiting (78%; grades 3/4: 9%), nausea (73%; grades 3/4: 15%), diarrhea (56%), abdominal pain (8% to 35%), anorexia (30%), gingival bleeding (17%), mucosal inflammation (16%), oral candidiasis (11%)
Genitourinary: Hematuria (13%)
Hematologic & oncologic: Leukopenia (grades 3/4: 88%), anemia (83%; grades 3/4: 75%), lymphocytopenia (grades 3/4: 82%), thrombocytopenia (81%; grades 3/4: 80%), neutropenia (grades 3/4: 10% to 64%), febrile neutropenia (55%; grades 3/4: 54%), petechia (26%)
Hepatic: Increased serum ALT (81%; grades 3/4: 43% to 44%), increased serum AST (74%; grades 3/4: 36%), increased bilirubin (45%; grades 3/4: 13%)
Infection: Infection (83%; includes bacterial, fungal, and viral), sepsis (including septic shock; 17%),
Local: Catheter infection (12%)
Neuromuscular & skeletal: Limb pain (30%), myalgia (14%)
Renal: Creatinine increased (50%; grades 3/4: 8%)
Respiratory: Epistaxis (27%), dyspnea (13%), pleural effusion (12%)
Miscellaneous: Fever (39%)
1% to 10%:
Cardiovascular: Pericardial effusion (8%), capillary leak syndrome (4%), hepatic veno-occlusive disease (2%)
Central nervous system: Drowsiness (10%), irritability (10%), lethargy (10%), agitation (5%), mental status changes (1% to 4%)
Dermatologic: Cellulitis (8%), pruritic rash (8%)
Gastrointestinal: Rectal pain (8%), pseudomembranous colitis (7%), stomatitis (7%), pancreatitis (1% to 4%), typhlitis (1% to 4%)
Hematologic & oncologic: Tumor lysis syndrome (grade 3: 6%), oral mucosal petechiae (5%)
Hepatic: Jaundice (8%), hyperbilirubinemia (1% to 4%; grade 4: 2%)
Hypersensitivity: Hypersensitivity (1% to 4%)
Infection: Herpes simplex infection (10%), bacteremia (9%), candidiasis (7%), herpes zoster (7%), staphylococcal bacteremia (6%), staphylococcal sepsis (5%), sepsis syndrome (2%)
Neuromuscular & skeletal: Back pain (10%), ostealgia (10%), weakness (10%), arthralgia (9%)
Respiratory: Pneumonia (10%), respiratory distress (10%), tachypnea (9%), upper respiratory tract infection (5%), pulmonary edema (1% to 4%)
<1% (Limited to important or life-threatening): Bone marrow failure, enterocolitis (occurs more frequently within 30 days of treatment and with combination chemotherapy), exfoliative dermatitis, gastrointestinal hemorrhage, hallucination (Jeha, 2006), hepatomegaly (Jeha, 2006), hypokalemia (Jeha, 2006), hyponatremia, hypophosphatemia, increased right ventricular pressure (Jeha, 2006), left ventricular systolic dysfunction (Jeha, 2006), major hemorrhage (including cerebral and pulmonary; majority of cases associated with thrombocytopenia), pancytopenia, Stevens-Johnson syndrome, syncope, toxic epidermal necrolysis
Concerns related to adverse effects:
• Bone marrow suppression: Dose-dependent, reversible myelosuppression (neutropenia, thrombocytopenia, and anemia) is common; may be severe and prolonged. Monitor blood counts and platelets. May be at increased risk for infection due to neutropenia. Monitor for signs and symptoms of infection and treat promptly if infection develops; may require discontinuation.
• Capillary leak syndrome/systemic inflammatory response syndrome (SIRS): Cytokine release syndrome (eg, tachypnea, tachycardia, hypotension, pulmonary edema) may develop into capillary leak syndrome/SIRS, and organ dysfunction; discontinue with signs/symptoms of SIRS or capillary leak syndrome (rapid-onset respiratory distress, hypotension, pleural/pericardial effusion, and multiorgan failure) and consider supportive treatment with diuretics, corticosteroids, and/or albumin. Prophylactic corticosteroids may prevent or diminish the signs/symptoms of cytokine release. May require dosage reduction.
• Dermatologic reactions: Serious and fatal cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been reported. Discontinue clofarabine for exfoliative or bullous rash, or if SJS or TEN are suspected.
• Gastrointestinal toxicity: Clofarabine is associated with a moderate emetic potential; antiemetics are recommended to prevent nausea and vomiting (Basch, 2011; Dupuis, 2011; Roila, 2010). Serious and fatal enterocolitis (including neutropenic colitis, cecitis, and C. difficile colitis) has been reported, usually occurring within 30 days of treatment, and when used in combination with other chemotherapy. May lead to complication including necrosis, perforation, hemorrhage or sepsis. Monitor for signs/symptoms of enterocolitis and manage promptly.
• Hemorrhage: Serious and fatal hemorrhages (including cerebral, gastrointestinal, and pulmonary hemorrhage) have occurred, usually associated with thrombocytopenia. Monitor and manage coagulation parameters.
• Hepatotoxicity: Transaminases and bilirubin may be increased during treatment; transaminase elevations generally occur within 10 days of administration and persist for ≤15 days. In some cases, hepatotoxicity was severe and fatal. The risk for hepatotoxicity, including hepatic sinusoidal obstruction syndrome (SOS; formerly called veno-occlusive disease [VOD]), is increased in patients who have previously undergone a hematopoietic stem cell transplant; discontinue if SOS is suspected. Avoid the concomitant use of drugs that may cause hepatotoxicity. Monitor liver function closely; may require therapy interruption or discontinuation.
• Hypotension: Monitor blood pressure during 5 days of treatment; discontinue if hypotension develops. Monitor if on concurrent medications known to affect blood pressure.
• Infection: The risk for infections, including opportunistic infection or sepsis (may be severe or fatal), is increased due to prolonged neutropenia and immunocompromised state. Monitor for signs and symptoms of infection and treat promptly if infection develops; may require therapy discontinuation.
• Renal toxicity: Elevated creatinine, acute renal failure, and hematuria were observed in clinical studies. Monitor renal function closely; may require dosage reduction or therapy discontinuation.
• Tumor lysis syndrome/hyperuricemia: Tumor lysis syndrome may occur as a consequence of leukemia treatment, including treatment with clofarabine, usually occurring in the first treatment cycle. May lead to life-threatening acute renal failure; adequate hydration and prophylactic antihyperuricemic therapy throughout treatment will reduce the risk/effects of tumor lysis syndrome; monitor closely.
• Hepatic impairment: Has not been studied in patients with hepatic impairment; use with caution. Canadian labeling contraindicates use in severe impairment or with history of serious hepatic disease.
• Renal impairment: A pharmacokinetic study demonstrated that systemic exposure increases as creatinine clearance decreases (CrCl <60 mL/minute) (Bonate, 2011). Dosage reduction required for moderate renal impairment (CrCl 30-60 mL/minute); use with caution in patients with CrCl <30 mL/minute (has not been studied). Minimize the use of drugs known to cause renal toxicity during the 5-day treatment period. Canadian labeling contraindicates use in severe impairment or with history of serious kidney disease.
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
• Hazardous agent: Use appropriate precautions for handling and disposal (NIOSH 2014 [group 1]).
CBC with differential and platelets (daily during treatment, then 1 to 2 times weekly or as necessary); liver and kidney function (during 5 days of clofarabine administration); coagulation parameters, blood pressure, cardiac function, and respiratory status during infusion; signs and symptoms of tumor lysis syndrome, infection, hepatic sinusoidal obstruction syndrome, enterocolitis, and cytokine release syndrome (tachypnea, tachycardia, hypotension, pulmonary edema); hydration status
Pregnancy Risk Factor
Adverse events were observed in animal reproduction studies. May cause fetal harm if administered to a pregnant woman. Women of childbearing potential should be advised to use effective contraception and avoid becoming pregnant during therapy.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience fatigue, flushing, dyspepsia, lack of appetite, anxiety, myalgia, arthralgia, back pain, painful extremities, or stomatitis. Have patient report immediately to prescriber signs of infection, strength differences from one side to another, difficulty speaking or thinking, change in balance, blurred vision, signs of hepatic impairment, signs of renal impairment, dyspnea, tachypnea, arrhythmia, angina, tachycardia, severe dizziness, syncope, considerable nausea, significant diarrhea, intolerable headache, mood changes, signs of hemorrhaging, epistaxis, severe asthenia, pallor, considerable skin irritation, eczema of hands or feet, signs of tumor lysis syndrome, intolerable dyspepsia, or signs of Stevens-Johnson syndrome/toxic epidermal necrolysis (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
More about clofarabine
- Other brands: Clolar