- Lomustine should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents.
Bone Marrow Suppression
- Bone marrow suppression, notably thrombocytopenia and leukopenia, which may contribute to bleeding and overwhelming infections in an already compromised patient, is the most common and severe of the toxic effects of lomustine (see WARNINGS and ADVERSE REACTIONS).
- Since the major toxicity is delayed bone marrow suppression, blood counts should be monitored weekly for at least 6 weeks after a dose (see ADVERSE REACTIONS). At the recommended dosage, courses of lomustine should not be given more frequently than every 6 weeks.
- The bone marrow toxicity of lomustine is cumulative and therefore dosage adjustment must be considered on the basis of nadir blood counts from prior dose (see dosage adjustment table under DOSAGE AND ADMINISTRATION).
MONITORING RECOMMENDATIONS RELATED TO BLACK BOX DATA
- Weekly blood cell counts for > 6 weeks post dose
Updated January 2018