A purine nucleoside antimetabolite that inhibits DNA repair by incorporation into the DNA chain during the repair process.

Recommended pediatric dose is 52 mg/m² administered by IV infusion over 2 hours daily for 5 consecutive days. Treatment cycles are repeated following recovery or return to baseline organ function, approximately every 2 to 6 weeks. The dosage is based on the actual height and weight before the start of each cycle.

Indicated for the treatment of patients who are 1-21 years old with relapsed or refractory acute lymphoblastic leukemia after at least two prior regimens.

Nausea, vomiting, diarrhea, bone marrow suppression, including anemia, leukopenia, thrombocytopenia, neutropenia and febrile neutropenia, infections, hepatobiliary toxicity and renal toxicity. Rare cases of systemic inflammatory response syndrome/capillary leak syndrome (SIRS) and cardiac toxicity, including tachycardia, pericardial effusion, and left ventricular systolic dysfunction.

Continuous IV fluid administration during the 5 days of chemotherapy administration is encouraged to reduce the risk of tumor lysis syndrome and other adverse effects.

Prophylactic steroids may be used to help prevent SIRS.

Monitor respiratory status and blood pressure during infusion. Monitor renal and hepatic function during the days of administration. Hematologic status should be monitored closely following treatment.