Patients should be hospitalized during the initial course of therapy due to possible severe toxic reactions. Poor risk patients w/ history of high dosage irradiation, previous use of alkylating agents, or who have a widespread involvement of bone marrow by metastatic tumors or impaired hepatic or renal function. Increased toxicity w/ any therapy which increases the stress of the patients, interferes w/ nutrition, or depresses bone marrow function. Severe hematological toxicity, GI haemorrhage & even death. Discontinue treatment if any sign of toxicity appears: stomatitis or esophagopharyngitis, leucopenia (WBC <3,500), or a rapidly falling WBC, thrombocytopenia (<100,000), haemorrhage from any site, GI ulceration & bleeding, severe diarrhea, intractable vomiting. Not to be used during pregnancy especially in the 1st trimester.
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