• Anthracycline (idarubicin, daunorubicin, doxorubicin): cardoitoxicity跟累積計量有關係

    較新的建議是累積劑量不要超過400至450 mg/m2。

  • Ara-C:
    • AE: fever, cerebellar ataxia, anal ulcer
    • 可過BBB
    • 可打sub-Q (LDAC)

    • 1000 mg/m2有中致吐性 (IDAC, HDAC)

    • prolonged infusion: higher toxicity & potency
  • Asparaginase: no myelosuppression; AE: hyperglycemia, hemorrhage (including ICH), thromboembolism, pancreatitis... (used in ALL and NK-T cell lymphoma/leukemia)
    • Asparaginase hydrolyzes L-asparagine to ammonia and L-aspartic acid, leading to depletion of asparagine. Leukemia cells, especially lymphoblasts, require exogenous asparagine; normal cells can synthesize asparagine. Asparagine depletion in leukemic cells leads to inhibition of protein synthesis and apoptosis. Asparaginase is cycle-specific for the G1 phase of the cell cycle.
  • ATG: thrombocytopenia, neutropenia, ATG-related serum sickness
    • Type III hypersensitivity, immune complex-mediated
    • 75% develop 7-10 days following administration
    • Fever, arthralgia, rash, vasculitis, proteinuria but not renal failure
    • Prednisolone 1mg/kg should be started on D5 to help prevent this
  • ATO: 10mg fix dose or 0.15mg/kg, oral form available but expensive
  • Bleomycin: 造成IPF的機率跟dose accumulation有關
  • Cisplatin: hypokalemia, hypomagnesemia, hypophosphatemia, renal impairment (RTA)
  • Carboplatin: thrombocytopenia
  • Endoxan: hematuria; high-dose: veno-occlusive liver disease, heart failure, methemoglobinemia
  • 5-FU: hyperammonemia; myocarditis?
  • Irrinotecan: acute cholinergic syndrome → atropine
  • Mitomycin, cisplatin, bleomycin, and gemcitabine: secondary HUS/TTP (gastric, lung, colorectal, pancreatic, and breast carcinoma)
  • Melphalan: secondary MDS or AML
  • MTX: renal & liver function impairment, myelosuppression