Bone Marrow Suppression; Pumonary Toxicity

• Use under supervision of experienced physician in the use of cancer chemotherapy

Bone Marrow suppression (notably thrombocytopenia & leukopenia)

• May contribute to bleeding and infections.
• Toxicity is cumulative, thus adjust dose based on nadir counts from prior doses.
• Do not repeat doses more frequently that every 6 weeks
• Perform weekly complete blood cell counts for at least six weeks post dose

Pulmonary Toxicity

• Dose related.
• Risk increases with cumulative doses > 1400 mg/m², history of lung disease and duration of therapy. Delayed cases of pulmonary fibrosis have been reported years after administration in childhood.