155 lines
66 KiB
Text
155 lines
66 KiB
Text
<!DOCTYPE html>
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" class="no-js no-jr">
|
|
<head>
|
|
<!-- For pinger, set start time and add meta elements. -->
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books">
|
|
<meta name="ncbi_pdid" content="book-part">
|
|
<meta name="ncbi_acc" content="NBK547931">
|
|
<meta name="ncbi_domain" content="livertox">
|
|
<meta name="ncbi_report" content="reader">
|
|
<meta name="ncbi_type" content="fulltext">
|
|
<meta name="ncbi_objectid" content="">
|
|
<meta name="ncbi_pcid" content="/NBK547931/?report=reader">
|
|
<meta name="ncbi_pagename" content="Mitoxantrone - LiverTox - NCBI Bookshelf">
|
|
<meta name="ncbi_bookparttype" content="chapter">
|
|
<meta name="ncbi_app" content="bookshelf">
|
|
<!-- Logger end -->
|
|
|
|
<!--component id="Page" label="meta"/-->
|
|
<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Mitoxantrone - LiverTox - NCBI Bookshelf</title>
|
|
<meta charset="utf-8">
|
|
<meta name="apple-mobile-web-app-capable" content="no">
|
|
<meta name="viewport" content="initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no">
|
|
<meta name="jr-col-layout" content="auto">
|
|
<meta name="jr-prev-unit" content="/books/n/livertox/Mitotane/?report=reader">
|
|
<meta name="jr-next-unit" content="/books/n/livertox/Mobocertinib/?report=reader">
|
|
<meta name="bk-toc-url" content="/books/n/livertox/?report=toc">
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE">
|
|
<meta name="citation_inbook_title" content="LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]">
|
|
<meta name="citation_title" content="Mitoxantrone">
|
|
<meta name="citation_publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases">
|
|
<meta name="citation_date" content="2020/02/19">
|
|
<meta name="citation_pmid" content="31643266">
|
|
<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK547931/">
|
|
<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
|
|
<meta name="DC.Title" content="Mitoxantrone">
|
|
<meta name="DC.Type" content="Text">
|
|
<meta name="DC.Publisher" content="National Institute of Diabetes and Digestive and Kidney Diseases">
|
|
<meta name="DC.Date" content="2020/02/19">
|
|
<meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK547931/">
|
|
<meta name="description" content="Mitoxantrone is an antineoplastic antibiotic that is used in the treatment of acute leukemia, lymphoma, and prostate and breast cancer, but also for late stage, severe multiple sclerosis. Mitoxantrone therapy is often accompanied by mild to moderate elevations in serum aminotransferase levels, but in typical doses it rarely causes clinically apparent, acute liver injury.">
|
|
<meta name="og:title" content="Mitoxantrone">
|
|
<meta name="og:type" content="book">
|
|
<meta name="og:description" content="Mitoxantrone is an antineoplastic antibiotic that is used in the treatment of acute leukemia, lymphoma, and prostate and breast cancer, but also for late stage, severe multiple sclerosis. Mitoxantrone therapy is often accompanied by mild to moderate elevations in serum aminotransferase levels, but in typical doses it rarely causes clinically apparent, acute liver injury.">
|
|
<meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK547931/">
|
|
<meta name="og:site_name" content="NCBI Bookshelf">
|
|
<meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png">
|
|
<meta name="twitter:card" content="summary">
|
|
<meta name="twitter:site" content="@ncbibooks">
|
|
<meta name="bk-non-canon-loc" content="/books/n/livertox/Mitoxantrone/?report=reader">
|
|
<link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK547931/">
|
|
<link href="https://fonts.googleapis.com/css?family=Archivo+Narrow:400,700,400italic,700italic&subset=latin" rel="stylesheet" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/libs.min.css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/jr.min.css">
|
|
<meta name="format-detection" content="telephone=no">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css//books_print.min.css" type="text/css" media="print">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_reader.min.css" type="text/css">
|
|
<style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style>
|
|
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico">
|
|
<meta name="ncbi_phid" content="CE8C4B647D7D3CB100000000014E010D.m_5">
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3849091.css"></head>
|
|
<body>
|
|
<!-- Book content! -->
|
|
|
|
|
|
<div id="jr" data-jr-path="/corehtml/pmc/jatsreader/ptpmc_3.22/"><div class="jr-unsupported"><table class="modal"><tr><td><span class="attn inline-block"></span><br />Your browser does not support the NLM PubReader view.<br />Go to <a href="/pmc/about/pr-browsers/">this page</a> to see a list of supported browsers<br />or return to the <br /><a href="/books/NBK547931/?report=classic">regular view</a>.</td></tr></table></div><div id="jr-ui" class="hidden"><nav id="jr-head"><div class="flexh tb"><div id="jr-tb1"><a id="jr-links-sw" class="hidden" title="Links"><svg xmlns="http://www.w3.org/2000/svg" version="1.1" x="0px" y="0px" viewBox="0 0 70.6 85.3" style="enable-background:new 0 0 70.6 85.3;vertical-align:middle" xml:space="preserve" width="24" height="24">
|
|
<style type="text/css">.st0{fill:#939598;}</style>
|
|
<g>
|
|
<path class="st0" d="M36,0C12.8,2.2-22.4,14.6,19.6,32.5C40.7,41.4-30.6,14,35.9,9.8"></path>
|
|
<path class="st0" d="M34.5,85.3c23.2-2.2,58.4-14.6,16.4-32.5c-21.1-8.9,50.2,18.5-16.3,22.7"></path>
|
|
<path class="st0" d="M34.7,37.1c66.5-4.2-4.8-31.6,16.3-22.7c42.1,17.9,6.9,30.3-16.4,32.5h1.7c-66.2,4.4,4.8,31.6-16.3,22.7 c-42.1-17.9-6.9-30.3,16.4-32.5"></path>
|
|
</g>
|
|
</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"><a href="/books/n/livertox/Mitotane/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="body"><div class="t">Mitoxantrone</div><div class="j">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]</div></div><div class="tail"><a href="/books/n/livertox/Mobocertinib/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 c-11.235,4.66-23.919,4.333-34.905-0.889l-28.723-13.653l-39.234,39.234l13.653,28.721c5.219,10.979,5.545,23.681,0.889,34.91 c-0.002,0.004-0.004,0.009-0.006,0.013c-4.649,11.214-13.834,19.931-25.271,23.998L50,228.257v55.485l29.98,10.661 c11.431,4.065,20.627,12.794,25.274,24c0.002,0.005,0.003,0.01,0.005,0.014c4.66,11.236,4.334,23.921-0.888,34.906l-13.654,28.723 l39.234,39.234l28.721-13.652c10.979-5.219,23.681-5.546,34.909-0.889c0.005,0.002,0.01,0.004,0.014,0.006 c11.214,4.649,19.93,13.833,23.998,25.271L228.257,462h55.484l10.595-29.79c4.103-11.538,12.908-20.824,24.216-25.525 c0.005-0.002,0.009-0.004,0.014-0.006c11.127-4.628,23.694-4.311,34.578,0.863l28.902,13.738l39.234-39.234l-13.66-28.737 c-5.214-10.969-5.539-23.659-0.886-34.877c0.002-0.005,0.004-0.009,0.006-0.014c4.654-11.225,13.848-19.949,25.297-24.021 L462,283.742z M256,331.546c-41.724,0-75.548-33.823-75.548-75.546s33.824-75.547,75.548-75.547 c41.723,0,75.546,33.824,75.546,75.547S297.723,331.546,256,331.546z"></path></svg></a><a id="jr-fip-sw" class="btn wsprkl hidden" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-rtoc-sw" class="btn wsprkl hidden" title="Table of Contents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,20h10v8H20V20zM36,20h44v8H36V20zM20,37.33h10v8H20V37.33zM36,37.33h44v8H36V37.33zM20,54.66h10v8H20V54.66zM36,54.66h44v8H36V54.66zM20,72h10v8 H20V72zM36,72h44v8H36V72z"></path></svg></a></div></div></nav><nav id="jr-dash" class="noselect"><nav id="jr-dash" class="noselect"><div id="jr-pi" class="hidden"><a id="jr-pi-prev" class="hidden" title="Previous page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a><div class="pginfo">Page <i class="jr-pg-pn">0</i> of <i class="jr-pg-lp">0</i></div><a id="jr-pi-next" class="hidden" title="Next page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div><div id="jr-is-tb"><a id="jr-is-sw" class="btn wsprkl hidden" title="Switch between Figures/Tables strip and Progress bar"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><rect x="10" y="40" width="20" height="20"></rect><rect x="40" y="40" width="20" height="20"></rect><rect x="70" y="40" width="20" height="20"></rect></svg></a></div><nav id="jr-istrip" class="istrip hidden"><a id="jr-is-prev" href="#" class="hidden" title="Previous"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M80,40 60,65 80,90 70,90 50,65 70,40z M50,40 30,65 50,90 40,90 20,65 40,40z"></path><text x="35" y="25" textLength="60" style="font-size:25px">Prev</text></svg></a><a id="jr-is-next" href="#" class="hidden" title="Next"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,40 40,65 20,90 30,90 50,65 30,40z M50,40 70,65 50,90 60,90 80,65 60,40z"></path><text x="15" y="25" textLength="60" style="font-size:25px">Next</text></svg></a></nav><nav id="jr-progress"></nav></nav></nav><aside id="jr-links-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">NCBI Bookshelf</div></div><div class="cnt lol f1"><a href="/books/">Home</a><a href="/books/browse/">Browse All Titles</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://www.facebook.com/sharer/sharer.php?u=https://www.ncbi.nlm.nih.gov/books/NBK547931/"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24" preserveAspectRatio="none"><g><path d="M 17.996,32L 12,32 L 12,16 l-4,0 l0-5.514 l 4-0.002l-0.006-3.248C 11.993,2.737, 13.213,0, 18.512,0l 4.412,0 l0,5.515 l-2.757,0 c-2.063,0-2.163,0.77-2.163,2.209l-0.008,2.76l 4.959,0 l-0.585,5.514L 18,16L 17.996,32z"></path></g></svg> Share on Facebook</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://twitter.com/intent/tweet?url=https://www.ncbi.nlm.nih.gov/books/NBK547931/&text=Mitoxantrone"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24"><g><path d="M 32,6.076c-1.177,0.522-2.443,0.875-3.771,1.034c 1.355-0.813, 2.396-2.099, 2.887-3.632 c-1.269,0.752-2.674,1.299-4.169,1.593c-1.198-1.276-2.904-2.073-4.792-2.073c-3.626,0-6.565,2.939-6.565,6.565 c0,0.515, 0.058,1.016, 0.17,1.496c-5.456-0.274-10.294-2.888-13.532-6.86c-0.565,0.97-0.889,2.097-0.889,3.301 c0,2.278, 1.159,4.287, 2.921,5.465c-1.076-0.034-2.088-0.329-2.974-0.821c-0.001,0.027-0.001,0.055-0.001,0.083 c0,3.181, 2.263,5.834, 5.266,6.438c-0.551,0.15-1.131,0.23-1.73,0.23c-0.423,0-0.834-0.041-1.235-0.118 c 0.836,2.608, 3.26,4.506, 6.133,4.559c-2.247,1.761-5.078,2.81-8.154,2.81c-0.53,0-1.052-0.031-1.566-0.092 c 2.905,1.863, 6.356,2.95, 10.064,2.95c 12.076,0, 18.679-10.004, 18.679-18.68c0-0.285-0.006-0.568-0.019-0.849 C 30.007,8.548, 31.12,7.392, 32,6.076z"></path></g></svg> Share on Twitter</a></div></aside><aside id="jr-rtoc-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Table of Content</div></div><div class="cnt lol f1"><a href="/books/n/livertox/?report=reader">Title Information</a><a href="/books/n/livertox/toc/?report=reader">Table of Contents Page</a></div></aside><aside id="jr-help-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Settings</div></div><div class="cnt f1"><div id="jr-typo-p" class="typo"><div><a class="sf btn wsprkl">A-</a><a class="lf btn wsprkl">A+</a></div><div><a class="bcol-auto btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 200 100" preserveAspectRatio="none"><text x="10" y="70" style="font-size:60px;font-family: Trebuchet MS, ArialMT, Arial, sans-serif" textLength="180">AUTO</text></svg></a><a class="bcol-1 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M15,25 85,25zM15,40 85,40zM15,55 85,55zM15,70 85,70z"></path></svg></a><a class="bcol-2 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M5,25 45,25z M55,25 95,25zM5,40 45,40z M55,40 95,40zM5,55 45,55z M55,55 95,55zM5,70 45,70z M55,70 95,70z"></path></svg></a></div></div><div class="lol"><a class="" href="/books/NBK547931/?report=classic">Switch to classic view</a><a href="/books/NBK547931/pdf/Bookshelf_NBK547931.pdf">PDF (134K)</a><a href="/books/NBK547931/?report=printable">Print View</a></div></div></aside><aside id="jr-bkhelp-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Help</div></div><div class="cnt f1 lol"><a id="jr-helpobj-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/help.xml" href="">Help</a><a href="mailto:info@ncbi.nlm.nih.gov?subject=PubReader%20feedback%20%2F%20NBK547931%20%2F%20sid%3ACE8B5AF87C7FFCB1_0191SID%20%2F%20phid%3ACE8C4B647D7D3CB100000000014E010D.4">Send us feedback</a><a id="jr-about-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/about.xml" href="">About PubReader</a></div></aside><aside id="jr-objectbox" class="thidden hidden"><div class="jr-objectbox-close wsprkl">✘</div><div class="jr-objectbox-inner cnt"><div class="jr-objectbox-drawer"></div></div></aside><nav id="jr-pm-left" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Previous Page</text></svg></nav><nav id="jr-pm-right" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Next Page</text></svg></nav><nav id="jr-fip" class="hidden"><nav id="jr-fip-term-p"><input type="search" placeholder="search this page" id="jr-fip-term" autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK547931_"><span class="title" itemprop="name">Mitoxantrone</span></h1><p class="fm-aai"><a href="#_NBK547931_pubdet_">Publication Details</a></p></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="Mitoxantrone.OVERVIEW"><h2 id="_Mitoxantrone_OVERVIEW_">OVERVIEW</h2><div id="Mitoxantrone.Introduction"><h3>Introduction</h3><p>Mitoxantrone is an antineoplastic antibiotic that is used in the treatment of acute leukemia, lymphoma, and prostate and breast cancer, but also for late stage, severe multiple sclerosis. Mitoxantrone therapy is often accompanied by mild to moderate elevations in serum aminotransferase levels, but in typical doses it rarely causes clinically apparent, acute liver injury.</p></div><div id="Mitoxantrone.Background"><h3>Background</h3><p>Mitoxantrone (mye tox’ an trone) is an antineoplastic antibiotic that is a synthetic derivative of doxorubicin and is considered an anthracenedione. It is believed to act by intercalating into helical double-stranded DNA causing cross links and strand breaks, thus blocking both DNA and RNA synthesis. Mitoxantrone has potent antitumor effects in vitro and has been evaluated in leukemia, lymphoma and several solid tumors in humans. Mitoxantrone also has immunosuppressive activity, inhibiting B cell, T cell and macrophage proliferation and decreasing tumor necrosis factor alpha and interleukin-2 secretion. These actions led to its evaluation in patients with progressive forms of multiple sclerosis where it was shown to have activity in decreasing the rates of relapse and development of new lesions. Mitoxantrone was approved for use in the United States in 1987 and current indications include acute non-lymphocytic leukemia and advanced prostate cancer. Mitoxantrone was subsequently approved for use in secondary progressive forms, progressive-relapsing forms and worsening relapsing-remitting forms of multiple sclerosis. Mitoxantrone is available in several generic formulations as a solution for intravenous injection (usually 2 mg/mL). Mitoxantrone is administered intravenously in doses typically ranging from 12 to 14 mg/m<sup>2</sup> at intervals of every 3 months (multiple sclerosis) or in monthly cycles (prostate cancer and leukemia). Side effects of mitoxantrone include bone marrow suppression, nausea, vomiting, abdominal discomfort, diarrhea, alopecia, headache, dizziness and rash. Serious side effects include febrile neutropenia, cardiac toxicity [similar to that caused by doxorubicin] and secondary leukemia [in patients with multiple sclerosis]. Mitoxantrone should be administered by a physician experienced in the use of cytotoxic chemotherapy and must be given intravenously slowly and carefully, as it can cause severe local tissue damage and should not be given subcutaneously, intramuscularly or intrathecally.</p></div><div id="Mitoxantrone.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Chemotherapy with mitoxantrone alone is associated with serum enzyme elevations in up to 40% of patients, but these elevations are generally mild-to-moderate in severity, transient and not accompanied by symptoms or jaundice. Higher rates of liver enzyme elevations have been reported with combination chemotherapeutic regimens that include mitoxantrone. In high doses, mitoxantrone has been associated with a high rate of jaundice, but the degree of hyperbilirubinemia has been mild, transient and not associated with significant serum enzyme elevations or evidence of hepatitis. Rare instances of acute liver injury have been reported in patients taking mitoxantrone, including a single case of drug-rash with eosinophilia and systemic symptoms (DRESS). The latency to onset was 8 weeks and the pattern of serum enzyme elevations was cholestatic and later mixed. Immunoallergic features were prominent and appeared to respond to corticosteroid therapy. Other drugs were being taken and the association with mitoxantrone was not definite (Case 1). Thus, idiosyncratic and clinically apparent liver injury from mitoxantrone may occur but is quite rare.</p><p>Likelihood score: D (possible rare cause of clinically apparent liver injury).</p></div><div id="Mitoxantrone.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The transient ALT elevations that can occur during mitoxantrone therapy are likely due to direct toxicity of the drug or its metabolites. Idiosyncratic acute liver injury attributed to mitoxantrone is likely due to a hypersensitivity reaction. Mitoxantrone is at least partially metabolized by the liver, but the specific pathways have not been well defined.</p></div><div id="Mitoxantrone.Outcome_and_Management"><h3>Outcome and Management</h3><p>The serum aminotransferase and mild serum bilirubin elevations that frequently accompany mitoxantrone therapy are generally self-limited, transient and unaccompanied by symptoms. The product label recommends regular monitoring of serum aminotransferase levels before each monthly or every-three-month infusion of mitoxantrone therapy, but dose modifications or discontinuation are rarely necessary. Patients who develop immunoallergic reactions to mitoxantrone should not be rechallenged with the medication. The possibility of cross reactivity with doxorubicin or other cytotoxic anthracycline antibiotics has not been evaluated, but should be done with caution.</p><p>Drug Class: <a href="https://www.ncbi.nlm.nih.gov/books/n/livertox/AntineoplasticAgents/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri"><u>Antineoplastic Agents</u></a>; <a href="https://www.ncbi.nlm.nih.gov/books/n/livertox/MultipleSclerosisAge/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri"><u>Multiple Sclerosis Agents</u></a></p><p>Other Drugs in the Subclass, <a href="/books/n/livertox/CytotoxicAntibiotics/?report=reader">Antibiotics, Cytotoxic</a>: <a href="/books/n/livertox/Bleomycin/?report=reader">Bleomycin</a>, <a href="/books/n/livertox/Dactinomycin/?report=reader">Dactinomycin</a>, <a href="/books/n/livertox/Daunorubicin/?report=reader">Daunorubicin</a>, <a href="/books/n/livertox/DoxorubicinEpirubici/?report=reader">Doxorubicin</a>, <a href="/books/n/livertox/DoxorubicinEpirubici/?report=reader">Epirubicin</a>, <a href="/books/n/livertox/DoxorubicinEpirubici/?report=reader">Idarubicin</a>, <a href="/books/n/livertox/Mitomycin/?report=reader">Mitomycin</a>, <a href="/books/n/livertox/Plicamycin/?report=reader">Plicamycin</a></p></div></div><div id="Mitoxantrone.CASE_REPORT"><h2 id="_Mitoxantrone_CASE_REPORT_">CASE REPORT</h2><div id="Mitoxantrone.Case_1_Drug_reaction_with_e"><h3>Case 1. Drug reaction with eosinophilia and systemic signs (DRESS) attributed to mitoxantrone therapy.(<a class="bibr" href="#Mitoxantrone.REF.1" rid="Mitoxantrone.REF.1">1</a>)</h3><p>A 44 year old woman with primary, progressive multiple sclerosis developed jaundice 8 weeks after starting mitoxantrone (10 mg every 4 weeks) and piracetam (3 gm daily). She was known to have multiple sclerosis for 3 years and had been treated previously with interferon beta with little clinical improvement. At the time of her third scheduled dose of mitoxantrone, she was found to be jaundiced and had mild fever and facial edema. Laboratory testing showed a total serum bilirubin of 19.3 mg/dL which was primarily direct. Serum ALT was 561 U/L, AST 337 U/L, alkaline phosphatase 705 U/L, GGT 447 U/L. These values had been normal in the past (Table). She took no other medications except for baclofen (75 mg daily), which she had been taking for almost two years. Her medications were stopped and she was admitted for evaluation. Tests for hepatitis A, B and C were negative as were routine autoantibodies. Abdominal ultrasound and magnetic resonance imaging were normal, without evidence of biliary obstruction. However, she failed to improve and after two weeks, her serum bilirubin remained high. A liver biopsy showed canalicular cholestasis with mild portal inflammation suggestive of drug induced liver injury. One week later, she developed a generalized, erythematous, macular rash and laboratory testing demonstrated leukocytosis (15,300/μL) and eosinophilia (>4000/μL). Methylprednisone was stated (20 mg daily) and she improved rapidly. Six months after initial presentation, all liver tests were normal and she underwent drug sensitivity skin testing which showed marked reactions to mitoxantrone, but none to piracetam.</p><div id="Mitoxantrone.Key_Points"><h4>Key Points</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figMitoxantroneTc"><a href="/books/NBK547931/table/Mitoxantrone.Tc/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figMitoxantroneTc" rid-ob="figobMitoxantroneTc"><img class="small-thumb" src="/books/NBK547931/table/Mitoxantrone.Tc/?report=thumb" src-large="/books/NBK547931/table/Mitoxantrone.Tc/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Mitoxantrone.Tc"><a href="/books/NBK547931/table/Mitoxantrone.Tc/?report=objectonly" target="object" rid-ob="figobMitoxantroneTc">Table</a></h4></div></div></div><div id="Mitoxantrone.Laboratory_Values"><h4>Laboratory Values</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figMitoxantroneTd"><a href="/books/NBK547931/table/Mitoxantrone.Td/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figMitoxantroneTd" rid-ob="figobMitoxantroneTd"><img class="small-thumb" src="/books/NBK547931/table/Mitoxantrone.Td/?report=thumb" src-large="/books/NBK547931/table/Mitoxantrone.Td/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Mitoxantrone.Td"><a href="/books/NBK547931/table/Mitoxantrone.Td/?report=objectonly" target="object" rid-ob="figobMitoxantroneTd">Table</a></h4></div></div></div><div id="Mitoxantrone.Comment"><h4>Comment</h4><p>A woman with multiple sclerosis developed jaundice and fever 8 weeks after starting the combination of mitoxantrone and piracetam. She did not improve immediately after stopping the medications and 3 weeks later developed skin rash and eosinophilia, fully warranting a diagnosis of DRESS syndrome. A liver biopsy demonstrated canalicular cholestasis, which is typical of the intrahepatic cholestasis that is caused by medications. The immunoallergic features of DRESS syndrome improved rapidly with methylprednisolone therapy (the duration of which was unclear), and serum bilirubin began to fall. In follow up 6 months later, she had recovered completely. Skin testing suggested that mitoxantrone rather than piracetam was the cause of the hypersensitivity reaction. Piracetam is a synthetic derivative of GABA, similar in structure to levetiracetam and used as treatment of myoclonus and for cognitive impairment. It is commercially available in Europe and elsewhere, but is not approved for use in the United States. While piracetam has not been specifically linked to hypersensitivity reactions, levetiracetam has been linked to cases of DRESS and Stevens Johnson syndrome. Thus, piracetam may have been the cause of the DRESS syndrome but, without rechallenge (negative or positive), it is impossible to definitively link this outcome to either agent. Certainly, the skin test reactions favor but do not prove the contribution of mitoxantrone.</p></div></div></div><div id="Mitoxantrone.PRODUCT_INFORMATION"><h2 id="_Mitoxantrone_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
|
|
<b>REPRESENTATIVE TRADE NAMES</b>
|
|
</p><p>Mitoxantrone – Generic, Novantrone®</p><p>
|
|
<b>DRUG CLASS</b>
|
|
</p><p>Antineoplastic Agents; Multiple Sclerosis Agents</p><p>
|
|
<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Mitoxantrone" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
|
|
</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div><div id="Mitoxantrone.CHEMICAL_FORMULA_AND_STRUCT"><h2 id="_Mitoxantrone_CHEMICAL_FORMULA_AND_STRUCT_">CHEMICAL FORMULA AND STRUCTURE</h2><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figMitoxantroneTe"><a href="/books/NBK547931/table/Mitoxantrone.Te/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figMitoxantroneTe" rid-ob="figobMitoxantroneTe"><img class="small-thumb" src="/books/NBK547931/table/Mitoxantrone.Te/?report=thumb" src-large="/books/NBK547931/table/Mitoxantrone.Te/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Mitoxantrone.Te"><a href="/books/NBK547931/table/Mitoxantrone.Te/?report=objectonly" target="object" rid-ob="figobMitoxantroneTe">Table</a></h4></div></div></div><div id="Mitoxantrone.CITED_REFERENCE"><h2 id="_Mitoxantrone_CITED_REFERENCE_">CITED REFERENCE</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="Mitoxantrone.REF.1">Caruso A, Vecchio R, Patti F, Neri S. Drug rash with eosinophilia and systemic signs syndrome in a patient with multiple sclerosis. <span><span class="ref-journal">Clin Ther. </span>2009;<span class="ref-vol">31</span>:580–4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19393848" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19393848</span></a>]</div></dd></dl></dl></div><div id="Mitoxantrone.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Mitoxantrone_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 19 February 2020</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Mitoxantrone.REF.zimmerman.1999">Zimmerman HJ. Anthracycline antibiotics. Hepatotoxic effects of oncotherapeutic and immunosuppressive agents. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 696-7.<div><i>(Expert review of hepatotoxicity published in 1999 mentions that mitoxantrone is associated with ALT elevations in 40% of patients when used alone and in 80% when used in combination chemotherapy, but the abnormalities are usually minor and "pose no important threat").</i></div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.deleve.2013">DeLeve LD. Cancer chemotherapy. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013, pp. 553.<div><i>(Review of hepatotoxicity of cancer chemotherapeutic agents mentions that mitoxantrone causes transient abnormalities in bilirubin and aminotransferase levels).</i></div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.wellstein.2018">Wellstein A, Giaccone G, Atkins MB, Sausville EA. Cytotoxic agents. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 1167-203.<div><i>(Textbook of pharmacology and therapeutics mentions that mitoxantrone is approved for use in acute non-lymphocytic leukemia, prostate cancer and late stage, progressive multiple sclerosis).</i></div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.paciucci.1986.805">Paciucci PA, Sklarin NT. Mitoxantrone and hepatic toxicity. <span><span class="ref-journal">Ann Intern Med. </span>1986;<span class="ref-vol">105</span>:805–6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3767174" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3767174</span></a>]<div>
|
|
<i>(Among 26 patients with leukemia treated with mitoxantrone, transient ALT and AST elevations occurred in 42% and bilirubin in 4%, 4-24 days after 5 day courses of the antineoplastic agent, resolving rapidly thereafter; among 19 patients treated with mitoxantrone, vincristine and prednisone, ALT elevations occurred after 80% of courses).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.shenkenberg.1986.67">Shenkenberg TD, Von Hoff DD. Mitoxantrone: a new anticancer drug with significant clinical activity. <span><span class="ref-journal">Ann Intern Med. </span>1986;<span class="ref-vol">105</span>:67–81.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3521429" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3521429</span></a>]<div>
|
|
<i>(Review of the biochemistry, mechanism of action, pharmacokinetics, clinical efficacy and safety of mitoxantrone in cancer chemotherapy; common side effects are mucositis, bone marrow suppression, and gastrointestinal intolerance; hepatotoxicity and ALT elevations were not mentioned).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.sznol.1987.237">Sznol M, Ohnuma T, Holland JF. Hepatic toxicity of drugs used for hematologic neoplasia. <span><span class="ref-journal">Semin Liver Dis. </span>1987;<span class="ref-vol">7</span>:237–56.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3317861" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3317861</span></a>]<div>
|
|
<i>(Overview of hepatotoxicity of antineoplastic agents, mentions that hepatotoxicity is not invariably described as a toxicity of mitoxantrone, suggesting that it is rare).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.vredenburgh.1988.187">Vredenburgh JJ, McIntyre OR, Cornwell GG 3rd, Ball ED, Cornell CJ, Mills LE, O'Donnell JF. Mitoxantrone in relapsed or refractory acute nonlymphocytic leukemia. <span><span class="ref-journal">Med Pediatr Oncol. </span>1988;<span class="ref-vol">16</span>:187–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/3380061" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3380061</span></a>]<div>
|
|
<i>(Among 17 patients with relapsed or refractory acute non-lymphocytic leukemia [ANLL] treated with 3 day courses of mitoxantrone, 9 [53%] developed elevated liver tests [>1.5 times ULN], but authors do not mention jaundice or clinically apparent liver injury).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.motawy.1992.475">Motawy MS, Khalifa F, Salfiti R, Patel JP. Mitoxantrone, cytosine-arabinoside and 6-thioguanine (MAT) in the treatment of newly diagnosed acute non-lymphoblastic leukemia in adults. <span><span class="ref-journal">Anticancer Drugs. </span>1992;<span class="ref-vol">3</span>:475–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1450441" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1450441</span></a>]<div>
|
|
<i>(Among 28 patients with newly diagnosed ANLL treated with 58 courses of mitoxantrone, cytarabine and thioguanine, major toxicities were bone marrow suppression, nausea, vomiting and stomatitis; hepatotoxicity occurred during 14 [24%] courses with Alk P elevation in all, ALT in 8 and bilirubin in 1, which resolved within an average of 12 days and did not recur upon reexposure).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.feldman.1993.2002">Feldman EJ, Alberts DS, Arlin Z, Ahmed T, Mittelman A, Baskind P, Peng YM, et al. Phase I clinical and pharmacokinetic evaluation of high-dose mitoxantrone in combination with cytarabine in patients with acute leukemia. <span><span class="ref-journal">J Clin Oncol. </span>1993;<span class="ref-vol">11</span>:2002–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8410125" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8410125</span></a>]<div>
|
|
<i>(Study of increasing doses of mitoxantrone [40 to 80 mg/m2/day for 2 days] in combination with cytarabine in 68 patients with leukemia found severe [>3 times ULN], but reversible hyperbilirubinemia in 32% of patients, with no mention of ALT elevations or symptomatic liver injury).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.avil_s.1994.168">Avilés A, Guzmán R, Talavera A, García EL, Díaz-Maqueo JC. Randomized study for the treatment of adult advanced Hodgkin's disease: epirubicin, vinblastine, bleomycin, and dacarbazine (EVBD) versus mitoxantrone, vinblastine, bleomycin, and dacarbazine (MVBD). <span><span class="ref-journal">Med Pediatr Oncol. </span>1994;<span class="ref-vol">22</span>:168–72.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/7505877" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7505877</span></a>]<div>
|
|
<i>(Among 70 patients with Hodgkin disease treated with vinblastine, bleomycin and dacarbazine combined with either epirubicin or mitoxantrone, 6 of those receiving mitoxantrone, but none receiving epirubicin, developed liver test abnormalities [>3 times ULN], which became chronic in two).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.millefiorini.1997.153">Millefiorini E, Gasperini C, Pozzilli C, D'Andrea F, Bastianello S, Trojano M, Morino S, et al. Randomized placebo-controlled trial of mitoxantrone in relapsing-remitting multiple sclerosis: 24-month clinical and MRI outcome. <span><span class="ref-journal">J Neurol. </span>1997;<span class="ref-vol">244</span>:153–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9050955" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9050955</span></a>]<div>
|
|
<i>(Among 51 patients with relapsing multiple sclerosis enrolled in a 2 year controlled trial of mitoxantrone versus placebo, side effects included nausea, diarrhea, and amenorrhea; no mention of ALT elevations or hepatotoxicity).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.edan.1997.112">Edan G, Miller D, Clanet M, Confavreux C, Lyon-Caen O, Lubetzki C, Brochet B, et al. Therapeutic effect of mitoxantrone combined with methylprednisolone in multiple sclerosis: a randomised multicentre study of active disease using MRI and clinical criteria. <span><span class="ref-journal">J Neurol Neurosurg Psychiatry. </span>1997;<span class="ref-vol">62</span>:112–8.</span> [<a href="/pmc/articles/PMC486720/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC486720</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/9048709" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9048709</span></a>]<div>
|
|
<i>(Among 42 patients with active multiple sclerosis treated with once monthly, intravenous methylprednisolone [MP] alone or with mitoxantrone, side effects of mitoxantrone included amenorrhea, stomatitis, nausea and vomiting; one patient on MP alone developed "hepatitis", but no details given).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.faggioli.1997.38">Faggioli P, De Paschale M, Tocci A, Luoni M, Fava S, De Paoli A, Tosi A, Cassi E. Acute hepatic toxicity during cyclic chemotherapy in non-Hodgkin’s lymphoma. <span><span class="ref-journal">Haematologica. </span>1997;<span class="ref-vol">82</span>:38–42.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9107080" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9107080</span></a>]<div>
|
|
<i>(Among 98 patients with lymphoma treated with various combinations of chemotherapy [21 received mitoxantrone], 20 had transient ALT elevations and 12 developed acute hepatitis, 8 in HBsAg positive patients and probably due to reactivation).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.bennett.2001.23">Bennett JM, Young MS, Liesveld JL, Paietta E, Miller KB, Lazarus HM, Marsh RD, et al. Phase II study of combination human recombinant GM-CSF with intermediate-dose cytarabine and mitoxantrone chemotherapy in patients with high-risk myelodysplastic syndromes (RAEB, RAEBT, and CMML): an Eastern Cooperative Oncology Group Study. <span><span class="ref-journal">Am J Hematol. </span>2001;<span class="ref-vol">66</span>:23–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11426487" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11426487</span></a>]<div>
|
|
<i>(Among 10 elderly patients with myelodysplastic syndromes treated with cytarabine, mitoxantrone and GM-CSF, bilirubin elevations occurred in 7 [2.2-22.4 mg/dL], but AST was raised in only 1 and alkaline phosphatase in 3 patients; 7 patients died of infectious complications).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.schaich.2002.808">Schaich M, Illmer T, Aulitzky W, Bodenstein H, Clemens M, Neubauer A, Repp R, et al. SHG AML96 Study Group. Intensified double induction therapy with high dose mitoxantrone, etoposide, m-amsacrine and high dose ara-C for elderly acute myeloid leukemia patients aged 61-65 years. <span><span class="ref-journal">Haematologica. </span>2002;<span class="ref-vol">87</span>:808–15.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12161356" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12161356</span></a>]<div>
|
|
<i>(Among 33 patients with acute myeloid leukemia treated with intensive chemotherapy with mitoxantrone, "grade 3 or 4 toxicity of the gastrointestinal tract and the liver" occurred in 48% of patients compared to only 21% of 39 patients given conventional chemotherapy).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.hartung.2002.2018">Hartung HP, Gonsette R, König N, Kwiecinski H, Guseo A, Morrissey SP, Krapf H, Zwingers T., Mitoxantrone in Multiple Sclerosis Study Group (MIMS). Mitoxantrone in progressive multiple sclerosis: a placebo-controlled, double-blind, randomised, multicentre trial. <span><span class="ref-journal">Lancet. </span>2002;<span class="ref-vol">360</span>(9350):2018–25.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12504397" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12504397</span></a>]<div>
|
|
<i>(Among 188 patients with progressive multiple sclerosis enrolled in a controlled trial of mitoxantrone vs placebo infusions every 3 months for two years, common side effects to standard doses of mitoxantrone included nausea [76%], alopecia [61%], stomatitis [19%] and diarrhea [16%]; serum ALT or AST elevations occurred in 8-9% of mitoxantrone versus 8% placebo recipients; no mention of jaundice or clinically apparent liver injury).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.chaudhuri.2003.1133">Chaudhuri A, Behan PO. Mitoxantrone trial in multiple sclerosis. <span><span class="ref-journal">Lancet. </span>2003;<span class="ref-vol">361</span>(9363):1133–4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12672341" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12672341</span></a>]<div>
|
|
<i>(Letter in response to Hartung [2002] raising issues regarding the safety and efficacy of mitoxantrone in multiple sclerosis; no mention of hepatotoxicity).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.cohen.2004.s28">Cohen BA, Mikol DD. Mitoxantrone treatment of multiple sclerosis: safety considerations. <span><span class="ref-journal">Neurology. </span>2004;<span class="ref-vol">63</span>(12) Suppl 6:S28–32.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15623667" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15623667</span></a>]<div>
|
|
<i>(Review of safety of mitoxantrone in treatment of multiple sclerosis mentions that mild-to-moderate elevations in ALT and sometimes bilirubin can occur, and recommends monitoring of routine liver tests before each infusion and deferring therapy if there are abnormalities).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.chalasani.2008.1924">Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, Yang H, Rochon J., Drug Induced Liver Injury Network (DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. <span><span class="ref-journal">Gastroenterology. </span>2008;<span class="ref-vol">135</span>:1924–34.</span> [<a href="/pmc/articles/PMC3654244/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3654244</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18955056" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18955056</span></a>]<div>
|
|
<i>(Among 300 cases of drug induced liver disease in the US collected between 2004 and 2008, several cases were attributed to antineoplastic agents [mercaptopurine, cyclophosphamide, docetaxel, temozolomide, bortezomib and imatinib], but none to mitoxantrone).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.caruso.2009.580">Caruso A, Vecchio R, Patti F, Neri S. Drug rash with eosinophilia and systemic signs syndrome in a patient with multiple sclerosis. <span><span class="ref-journal">Clin Ther. </span>2009;<span class="ref-vol">31</span>:580–4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19393848" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19393848</span></a>]<div>
|
|
<i>(44 year old woman with multiple sclerosis developed fever, rash and jaundice 8 weeks after starting piracetam [a neuroenhancing derivative of GABA not available in the US] and mitoxantrone [bilirubin 19.3 mg/dL, ALT 561 U/L, Alk P 705 U/L, eosinophils >4000/uL], resolving with corticosteroid therapy and later having positive skin test reactions to mitoxantrone: Case 1).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.wundes.2010.876">Wundes A, Kraft GH, Bowen JD, Gooley TA, Nash RA. Mitoxantrone for worsening multiple sclerosis: tolerability, toxicity, adherence and efficacy in the clinical setting. <span><span class="ref-journal">Clin Neurol Neurosurg. </span>2010;<span class="ref-vol">112</span>:876–82.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20727669" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20727669</span></a>]<div>
|
|
<i>(Retrospective analysis of 96 patients with multiple sclerosis treated with 534 infusions of mitoxantrone over a 6 year period at a single referral center; common side effects were nausea [64%], fatigue [53%], infections [33%], alopecia [33%], gastrointestinal upset [22%] and amenorrhea [18% of women]; no mention of ALT elevations or hepatotoxicity).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.reuben.2010.2065">Reuben A, Koch DG, Lee WM., Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. <span><span class="ref-journal">Hepatology. </span>2010;<span class="ref-vol">52</span>:2065–76.</span> [<a href="/pmc/articles/PMC3992250/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3992250</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20949552" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20949552</span></a>]<div>
|
|
<i>(Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 were attributed to drug induced liver injury, including 2 attributed to antineoplastic agents [melphalan and gemtuzumab], but none to mitoxantrone).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.k_mpfel.2011.495">Kümpfel T, Gerdes LA, Flaig M, Hohlfeld R, Wollenberg A. Drug-induced Sweet's syndrome after mitoxantrone therapy in a patient with multiple sclerosis. <span><span class="ref-journal">Mult Scler. </span>2011;<span class="ref-vol">17</span>:495–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21148263" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21148263</span></a>]<div>
|
|
<i>(55 year old man with multiple sclerosis developed acute febrile neutropenic dermatitis [Sweet syndrome], 7 days after a 5th three-monthly infusion of mitoxantrone which responded to stopping therapy and corticosteroids, but relapsed upon tapering dose; no mention of liver test results).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.kim.2012.479">Kim JW, Lee HJ, Yi HG, Kim BS, Bang SM, Kim JS, Kim I, et al. Mitoxantrone, etoposide, cytarabine, and melphalan (NEAM) followed by autologous stem cell transplantation for patients with chemosensitive aggressive non-Hodgkin lymphoma. <span><span class="ref-journal">Am J Hematol. </span>2012;<span class="ref-vol">87</span>:479–83.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/22388671" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22388671</span></a>]<div>
|
|
<i>(Among 69 patients with lymphoma undergoing combination chemoablation including mitoxantrone followed by HST, adverse events included mucositis [100%], febrile neutropenia [88%] and "grade 3 or 4 hepatic toxicity" in 10%, but no details given).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.hern_ndez.2014.231">Hernández N, Bessone F, Sánchez A, di Pace M, Brahm J, Zapata R, A, Chirino R, et al. Profile of idiosyncratic drug induced liver injury in Latin America: an analysis of published reports. <span><span class="ref-journal">Ann Hepatol. </span>2014;<span class="ref-vol">13</span>:231–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24552865" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24552865</span></a>]<div>
|
|
<i>(Among 176 reports of drug induced liver injury from Latin America published between 1996 and 2012, ten cases were attributed to antineoplastic agents, but none to mitoxantrone).</i>
|
|
</div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.chalasani.2015">Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al.; United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. Gastroenterology 2015; 148: 1340-52. e7. [<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div><i>(Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, 49 cases were attributed to antineoplastic agents, but none to mitoxantrone).</i></div></div></li><li><div class="bk_ref" id="Mitoxantrone.REF.antonazzo.2019.1633">Antonazzo IC, Poluzzi E, Forcesi E, Riise T, Bjornevik K, Baldin E, Muratori L, et al. Liver injury with drugs used for multiple sclerosis: contemporary analysis of the FDA Adverse Event Reporting System. <span><span class="ref-journal">Mult Scler. </span>2019;<span class="ref-vol">25</span>:1633–40.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30230957" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30230957</span></a>]<div>
|
|
<i>(Analysis of hepatic adverse events attributed to drugs used to treat multiple sclerosis reported to the FDA between 2004 and 2016 identified 4873 cases of “severe liver injury”, most commonly due to interferon beta-1a [2343], interferon beta-1b [535], natalizumab [759], fingolimod [496], dimethyl fumarate [223], and glatiramer [212], but also mitoxantrone [131]; no specific clinical details provided).</i>
|
|
</div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK547931_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">February 19, 2020</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Mitoxantrone. [Updated 2020 Feb 19].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/livertox/Mitotane/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/livertox/Mobocertinib/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article><article data-type="table-wrap" id="figobMitoxantroneTc"><div id="Mitoxantrone.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK547931/table/Mitoxantrone.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Mitoxantrone.Tc_lrgtbl__"><table><tbody><tr><th id="hd_b_Mitoxantrone.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medication:</th><td headers="hd_b_Mitoxantrone.Tc_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mitoxantrone (10 mg intravenously, 2 doses)</td></tr><tr><th id="hd_b_Mitoxantrone.Tc_1_1_2_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pattern:</th><td headers="hd_b_Mitoxantrone.Tc_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cholestatic (R=1.9)</td></tr><tr><th id="hd_b_Mitoxantrone.Tc_1_1_3_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severity:</th><td headers="hd_b_Mitoxantrone.Tc_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3+ (jaundice and hospitalization)</td></tr><tr><th id="hd_b_Mitoxantrone.Tc_1_1_4_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Latency:</th><td headers="hd_b_Mitoxantrone.Tc_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 months</td></tr><tr><th id="hd_b_Mitoxantrone.Tc_1_1_5_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recovery:</th><td headers="hd_b_Mitoxantrone.Tc_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 months</td></tr><tr><th id="hd_b_Mitoxantrone.Tc_1_1_6_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other medications:</th><td headers="hd_b_Mitoxantrone.Tc_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Piracetam, baclofen</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobMitoxantroneTd"><div id="Mitoxantrone.Td" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK547931/table/Mitoxantrone.Td/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Mitoxantrone.Td_lrgtbl__"><table><thead><tr><th id="hd_h_Mitoxantrone.Td_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Starting</th><th id="hd_h_Mitoxantrone.Td_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Stopping</th><th id="hd_h_Mitoxantrone.Td_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">ALT<br />(U/L)</th><th id="hd_h_Mitoxantrone.Td_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Alk P<br />(U/L)</th><th id="hd_h_Mitoxantrone.Td_1_1_1_5" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Bilirubin<br />(mg/dL)</th><th id="hd_h_Mitoxantrone.Td_1_1_1_6" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Other</th></tr></thead><tbody><tr><td headers="hd_h_Mitoxantrone.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Normal</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Normal</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Normal</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Mitoxantrone.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 weeks</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">561</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">705</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">19.3</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fever, facial edema</td></tr><tr><td headers="hd_h_Mitoxantrone.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 weeks</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2 weeks</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Mitoxantrone.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Mitoxantrone.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">19.9</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Liver biopsy</td></tr><tr><td headers="hd_h_Mitoxantrone.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11 weeks</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 weeks</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">647</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">693</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">18.1</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rash, corticosteroids started</td></tr><tr><td headers="hd_h_Mitoxantrone.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 weeks</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 weeks</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Mitoxantrone.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Mitoxantrone.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">8.5</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Discharged</td></tr><tr><td headers="hd_h_Mitoxantrone.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 months</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 months</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Normal</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Normal</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Normal</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Skin testing</td></tr><tr><td headers="hd_h_Mitoxantrone.Td_1_1_1_1 hd_h_Mitoxantrone.Td_1_1_1_2" colspan="2" scope="row" rowspan="1" style="text-align:center;vertical-align:top;">
|
|
<b>Normal Values</b>
|
|
</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<b><45</b>
|
|
</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<b><115</b>
|
|
</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
|
<b><1.2</b>
|
|
</td><td headers="hd_h_Mitoxantrone.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobMitoxantroneTe"><div id="Mitoxantrone.Te" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK547931/table/Mitoxantrone.Te/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Mitoxantrone.Te_lrgtbl__"><table><tbody><tr><th id="hd_b_Mitoxantrone.Te_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_b_Mitoxantrone.Te_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NO.</th><th id="hd_b_Mitoxantrone.Te_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_b_Mitoxantrone.Te_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr><tr><td headers="hd_b_Mitoxantrone.Te_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mitoxantrone</td><td headers="hd_b_Mitoxantrone.Te_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135007017" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">70476-82-3</a>
|
|
</td><td headers="hd_b_Mitoxantrone.Te_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C22-H28-N4-O6.2Cl-H</td><td headers="hd_b_Mitoxantrone.Te_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135007017" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=135007017" alt="image 135007017 in the ncbi pubchem database" /></a>
|
|
</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
|
|
|
|
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal105 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3968615.js" snapshot="books"></script></body>
|
|
</html>
|