Cladribine

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Cladribine

Definition

Cladribine, also known by the brand name Leustatin, is a chemotherapy medicine used to treat certain types of cancer by destroying cancerous cells.

Purpose

Cladribine is approved by the Food and Drug Administration (FDA) to treat active hairy cell leukemia . It has also been used to treat other types of leukemias and lymphomas.

Description

A member of the group of chemotherapy drugs known as a purine nucleoside analog, cladribine may also be referred to as 2-CdA, chlorodeoxyadenosine, and 2-chlorodeoxyadenosine. The purine nucleosides interfere with the genetic material (DNA) inside the cancer cells, cause DNA strand breaks, and block RNA synthesis. These traits help prevent cancer cells from further dividing and growing and also may cause the cancer cells to die.

Recommended dosage

Cladribine is a clear solution that is administered through a vein. The dose of cladribine is based on a patient's weight in kilograms. The approved dose for hairy cell leukemia is 0.09 mg per kilogram of body weight administered each day as a continuous intravenous infusion administered over 24 hours each day for seven continuous days. Some patients may receive this treatment in more than one cycle.

Other doses include 0.1 to 0.3 mg per kilogram of body weight per day for seven days administered as a continuous infusion. Patients may also receive cladribine as a two-hour infusion daily for five days in a row.

Precautions

Blood counts will be monitored regularly while on cladribine therapy. During a certain time period after receiving cladribine, there is an increased risk of getting infections. Caution should be taken to avoid unnecessary exposure to crowds and people with infection.

Patients with a known previous allergic reaction to chemotherapy drugs should tell their doctor.

Patients who may be pregnant or are trying to become pregnant should tell their doctors before receiving cladribine.

Although chemotherapy can cause men and women to be sterile (not able to have children), it is unknown if cladribine has this effect on humans.

Patients should check with their doctors before receiving live virus vaccines while on chemotherapy.

Side effects

The most common side effect from taking cladribine is low blood counts, referred to as myelosuppression . When the white blood cell count is lower than normal, referred to as neutropenia , patients are at an increased risk of developing a fever and infections. The platelet blood count can also be decreased due to cladribine administration, but generally returns back to normal within two weeks after the end of the infusion. Platelets are blood cells in the body that cause clots to form these clots stop bleeding. When the platelet count is low, patients are at an increased risk for bruising and bleeding. Cladribine causes low red blood cell counts, which is referred to as anemia . Low red counts make people feel tired and dizzy.

Other common side effects of cladribine include skin rashes or reactions, pain, redness, or swelling at the injection site. Half of patients with hairy cell leukemia experience a rash.

Patients may experience infections, chills, and fever when being treated with cladribine. This may result in treatment with antibiotics .

Nausea, vomiting, loss of appetite, abdominal pain, constipation and diarrhea are mild side effects from cladribine. If nausea and vomiting are a problem, patients can be given medicines known as antiemetics before receiving cladribine to help prevent or decrease these side effects.

Damage to the kidneys and nervous system tissues is uncommon with cladribine, unless given in high doses for bone marrow transplant patients. At high doses, kidney problems and nerve damage have resulted in weakness of the arms and legs.

Less common side effects of cladribine are hair loss, itching , a fever from taking the drug, lung problems, cough, inability to sleep, headache, dizziness, fast heart rate, muscle and joint aches, and fatigue .

Interactions

Patients should notify their doctors of any medications they are taking. In the case of cladribine, medications to make special note of include antithyroid agents, azathioprine , chloramphenicol, flucytosine, ganciclovir, interferon, plicamycin , zidovudine, probenecid, sulfinpyrazone.

Patients should tell their doctors if they have a known allergic reaction to amifostine or any other medications or substances, such as foods and preservatives. Before taking any new medications, including nonprescription medications, vitamins , and herbal medications, the patients should notify their doctors.

Nancy J. Beaulieu, RPh., BCOP

KEY TERMS

Anemia

—A red blood cell count that is lower than normal.

Complete response

—No sign of leukemia in the blood or bone marrow.

Chemotherapy

—Specific drugs used to treat cancer.

DNA

—Genetic material inside of cells that that carry information to make proteins that are necessary for proper cell functioning.

Food and Drug Administration

—A government agency that oversees public safety in relation to drugs and medical devices. The FDA gives approval to pharmaceutical companies for commercial marketing of their products