Indications & Dose: ALLOGENIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IV Adult 0.8mg/kg q6h 4 days. Starting 6h after 16th dose of busulfan inj, give cyclophosphamide 60mg/kg/day (as IV over 1h for 2 days) Child <12 kg: 1.1mg/kg, >12kg 0.8mg/kg | CHRONIC MYELOGENOUS LEUKEMIA PO Adult Remission induction: 4-8mg/day until WBC count decreases to 15, 000/mm3, then discontinue drug until WBC count rises to 50, 000/mm3, and then resume as needed Child 0.06-0.12mg/kg/day or 1.8-4.6mg/m2/day. Adjust dosage to maintain WBC count at ~20, 000/mm3. Drug should be withheld when WBC count decreases to ~15, 000/mm3

Precautions: History of seizures/head trauma, avoid contact with skin & eyes, active infect, concurrent myelosuppressive/radiation therapy

ADR: Serious: Bone-marrow depression, blood disorders, liver damage, interstitial pulmonary fibrosis, Addison’s disease, arrhythmia, cardiomegaly, atrial fibrillation, ECG abnormal, heart block, HF, pericardial effusion, ventricular extrasystoles, hypervolemia, hypokalemia, hypophosphatemia, hypocalcemia, seizure, impaired fertility & gonadal function, cataract, Others: erythema nodosum, ovarian failure, rash, pruritus, alopecia, increased PT, hematuria, dysuria, hyperpigmentation, GI disturbances, dry skin & other skin reactions, gynecomastia

DDI: Serious Paracetamol decrease drug clearance, Phenytoin decrease drug levels, Ketobemidone/Itraconazole increase drug levels, Metronidazole increases drug levels & leads to toxicity, Ketoconazole increases risk of hepatic veno-occlusive disease, Tioguanine increases risk of nodular regenerative hyperplasia of liver, portal hypertension & oesophageal varices

Monitor: CBC, LFTs, alkaline phosphatase & bilirubin