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Treatment Name: Liposomal Vincristine (Marqibo®)

Liposomal Vincristine (Marqibo®) is a Chemotherapy Regimen for Acute Lymphoid Leukemia (ALL)

How does liposomal vincristine work?
Liposomal vincristine is designed to kill leukemia cells. The liposomal form of vincristine allows the drug to stay in the body longer compared to the conventional formulation.

Goals of therapy:
Liposomal vincristine is given to kill leukemia cells and restore normal bone marrow function. Liposomal vincristine is given with the goal of achieving disease remission or to prevent the leukemia cells from growing. Liposomal vincristine is not commonly given with the goal of cure.


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  • Liposomal vincristine intravenous infusion, usually given over 1 hour on Day 1 of each cycle

Liposomal vincristine is usually given in an outpatient infusion center, allowing the person to go home afterwards.

Liposomal vincristine is repeated every 7 days. This is known as one cycle. Each cycle is repeated until the drug stops working, unacceptable toxicity occurs, or a bone marrow transplant can be arranged

Click here for the common starting dose.

Side Effects

In clinical studies, the most commonly reported liposomal vincristine (Marqibo®) side effects are shown here:

Side effect videos Side Effect Videos
ConstipationConstipationNausea and VomitingNausea and VomitingFatigue Fatigue DiarrheaDiarrhea


How often monitoring needed?
Labs (blood tests) will be checked before treatment then periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), uric acid, Lactate Dehydrogenase (LDH), plus any others your doctor may order

How often is imaging needed?
Imaging may be checked before treatment or during treatment if there is concern for a blood clot or infection. Imaging may include: x-rays or computerized tomography (CT) scans

How might blood test results/imaging affect treatment?
A bone marrow biopsy is done typically after 4 weeks of therapy. Depending upon the bone marrow results, your doctor may advise to continue chemotherapy as planned or switch to a different therapy

ChemoExperts Tips

  • Marqibo should be scheduled as the first or second infusion of the day because the pharmacy will need at least one hour to prepare the drug. Please be patient with them as the time to preparation often cannot be shortened
  • Allopurinol may be prescribed for the first cycle of chemotherapy to help prevent tumor lysis syndrome
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for ALL. Ask your doctor if any studies are currently enrolling in your area. If not, go to to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Liposomal Vincristine (Marqibo®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Liposomal Vincristine (Marqibo®). Depending upon your income, they may be able to help cover the cost of:

  • Liposomal Vincristine

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Liposomal Vincristine (Marqibo®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Liposomal Vincristine (Marqibo®)

Individual Drug Label Information

Liposomal Vincristine (Marqibo®)

  • Liposomal vincristine MUST only be given by intravenous infusion. May NOT be administered any other way 
  • Dosage adjustments may be required for liver impairment, low blood counts, or nerve pain 
  • May interact with certain antifungal and seizure medications. Ask your doctor or pharmacist to review your medications for any possible interactions  
  • May interact with grapefruit and grapefruit juice causing increased blood levels of liposomal vincristine. This could increase your risk of experiencing side effects. Avoid eating grapefruit and drinking anything containing grapefruit juice during treatment  
  • Avoid therapy with St. Johns Wort as it will decrease blood levels of liposomal vincristine. This could decrease the effectiveness of treatment 
General Liposomal Vincristine (Marqibo) Side Effects 
  • Commonly causes constipation; preventative medicines may help decrease or avoid constipation 
  • Can cause nerve damage. Notify your doctor if you experience tingling or numbness in fingers or toes, decreased reflexes, nerve pain, jaw pain, muscle pain, joint pain, muscle spasm, or muscle weakness 
  • Can cause significant liver damage. Liver function tests will be monitored throughout treatment. 
  • Low red blood cells, white blood cells, and platelets can occur 
  • Click on the liposomal vincristine (Marqibo) package insert below for reported side effects and possible drug interactions

Side Effect Videos
DiarrheaDiarrheaFatigue Fatigue ConstipationConstipation

See DailyMed package insert.

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O’Brien S, Schiller G, Lister J, et al. High-dose vincristine sulfate liposome Injection for advanced, relapsed, and refractory adult Philadelphia chromosome–negative acute lymphoblastic leukemia. J Clin Oncol. 2013;31:676-683.

Created: September 9, 2015 Updated: September 10, 2018

What is Acute Lymphoid Leukemia (ALL)?

Acute Lymphoid Leukemia (ALL), also known as acute lymphoblastic leukemia, is a disease of the lymphoid cells found in the bone marrow. Lymphoid cells are responsible for developing into cells of the immune system called B-cells, T-cells, or Natural Killer cells. In ALL, immature lymphoid cells know as "blasts" replicate at a very fast rate. Sometimes blasts crowd out the normal cells in the bone marrow so that red blood cells or platelets are unable to develop.

Common symptoms of ALL include fatigue, infection, and bruising or bleeding. ALL is the most common cancer diagnosed in children, but is rare in adults. Most cases of ALL are considered "de novo" meaning that the cause is unknown; however, some cases can be linked to certain genetic syndromes. There is no staging system for ALL. Chromosomes are often analyzed to determine which mutations in the chromosomes exist. The effectiveness of the treatment may depend upon the specific chromosome mutations that are present.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose your therapy.

What is Tumor Lysis Syndrome?

Tumor lysis syndrome occurs when many cancer cells die quickly and release their contents into the bloodstream. Many times the body has the ability to flush these substances out through the kidneys or metabolize them via the liver. However, sometimes the body needs medicines to help eliminate these substances and to prevent organ damage.

Common Starting dose

Liposomal vincristine 2.25 mg/m2 intravenous infusion over one hour on Day 1

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

14) Serum calcium

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.