Cladribine Brand Name– Leustatin | MAVENCLAD
What is Cladribine
Cladribine is a synthetic purine nucleoside antimetabolite.
It belongs to the antimetabolite class of antineoplastics but is most closely related to other purine analogs such as fludarabine, mercaptopurine, pentostatin, and thioguanine.
Cladribine is an adenosine deaminase (ADA)-resistant analog of deoxyadenosine, with demonstrated activity in vitro against both lymphoid and myeloid neoplasms.
Cladribine is not active against solid tumors. Favorable results have been seen with parenteral cladribine in the treatment of hairy cell leukemia (HCL).
Cladribine also may be efficacious in the treatment of acute myelogenous leukemia (AML) in children, chronic lymphocytic leukemia (CLL), Waldenstrom’s macroglobulinemia, cutaneous T-cell lymphoma, and non-Hodgkin’s lymphoma.
A distinguishing feature of cladribine is its activity against both dividing and nondividing cells.
In comparison with other agents approved for the treatment of HCL, cladribine’s shorter duration of therapy and lower overall cost make it an attractive choice over interferon alfa or pentostatin.
Oral cladribine is indicated for the treatment of relapsing forms of multiple sclerosis, including relapsing-remitting disease and active secondary progressive disease.
In clinical trials, patients treated with oral cladribine experienced a 58% relative risk reduction in annual relapse rate compared to those treated with placebo (0.14 vs. 0.33, p less than 0.001).
Serious, generally dose-dependent and reversible, bone marrow suppression, including anemia, lymphopenia, neutropenia, thrombocytopenia, and pancytopenia have been reported with cladribine therapy.
Cladribine may increase the risk of infection due to immunosuppression; serious, including fatal, infections have been reported with cladribine.
Indications
- acute myelogenous leukemia (AML)
- chronic lymphocytic leukemia (CLL)
- cutaneous T-cell lymphoma (CTCL)
- hairy-cell leukemia
- multiple sclerosis
- mycosis fungoides
- non-Hodgkin’s lymphoma (NHL)
For the treatment of relapsing forms of multiple sclerosis, including relapsing-remitting disease and active secondary progressive disease
NOTE: Cladribine is not for use in patients with clinically isolated syndrome because of its safety profile.
Side Effects
- abdominal pain
- alopecia
- anemia
- anorexia
- anuria
- anxiety
- aplastic anemia
- arthralgia
- asthenia
- back pain
- bleeding
- bone marrow suppression
- bone pain
- chest pain (unspecified)
- chills
- confusion
- conjunctivitis
- constipation
- cough
- depression
- diarrhea
- dizziness
- dyspnea
- ecchymosis
- edema
- elevated hepatic enzymes
- eosinophilia
- erythema
- fatigue
- fever
- fever
- flatulence
- graft-versus-host disease (GVHD)
- headache
- heart failure
- hemolytic anemia
- hepatitis
- hyperhidrosis
- hypertension
- infection
- infection
- injection site reaction
- insomnia
- lymphopenia
- maculopapular rash
- malaise
- myalgia
- nausea
- nephrotoxicity
- neurotoxicity
- neutropenia
- new primary malignancy
- pancytopenia
- peripheral edema
- peripheral neuropathy
- petechiae
- phlebitis
- pneumonitis
- progressive multifocal leukoencephalopathy
- pruritus
- pulmonary fibrosis
- purpura
- rash
- renal failure (unspecified)
- seizures
- sinus tachycardia
- Stevens-Johnson syndrome
- teratogenesis
- thrombocytopenia
- toxic epidermal necrolysis
- tumor lysis syndrome (TLS)
- urticaria
- vomiting
- weakness
- wheezing
Monitoring Parameters
- CBC with differential
- hepatitis B serology
- LFTs
- pregnancy testing
- serum bilirubin
- serum creatinine/BUN
- skin cancer screening exam
- tuberculin skin test
Contraindications
- bone marrow suppression
- breast-feeding
- contraception requirements
- hepatic disease
- hepatitis
- herpes infection
- human immunodeficiency virus (HIV) infection
- infection
- neonates
- nephrotoxicity
- neurotoxicity
- new primary malignancy
- pregnancy
- pregnancy testing
- premature neonates
- progressive multifocal leukoencephalopathy
- renal disease
- renal failure
- renal impairment
- reproductive risk
- requires an experienced clinician
- tuberculosis
- vaccination
Interactions
- Alpha interferons
- Amlodipine; Celecoxib
- Antithymocyte Globulin
- Azelastine; Fluticasone
- Bacillus Calmette-Guerin Vaccine, BCG
- Basiliximab
- Beclomethasone
- Betamethasone
- Budesonide
- Budesonide; Formoterol
- Carbamazepine
- Celecoxib
- Ciclesonide
- Clozapine
- Corticosteroids
- Cortisone
- Cyclosporine
- Deflazacort
- Dexamethasone
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Digoxin
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Echinacea
- Efalizumab
- Esomeprazole; Naproxen
- Etodolac
- Famotidine; Ibuprofen
- Febuxostat
- Fenoprofen
- Filgrastim, G-CSF
- Fludrocortisone
- Flunisolide
- Flurbiprofen
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Formoterol; Mometasone
- Hydrocodone; Ibuprofen
- Hydrocortisone
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Indomethacin
- Influenza Virus Vaccine
- Interferon Alfa-2a
- Interferon Alfa-2b
- Interferon Alfa-2b; Ribavirin
- Interferon Alfa-n3
- Interferon Alfacon-1
- Intranasal Influenza Vaccine
- Ketoprofen
- Ketorolac
- Lansoprazole; Naproxen
- Live Vaccines
- Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
- Measles/Mumps/Rubella Vaccines, MMR
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Methotrexate
- Methylprednisolone
- Mometasone
- Muromonab-CD3
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Nonsteroidal antiinflammatory drugs
- Oxaprozin
- Ozanimod
- Palifermin
- Pegfilgrastim
- Peginterferon Alfa-2a
- Peginterferon Alfa-2b
- Penicillamine
- Piroxicam
- Platelet Inhibitors
- Prednisolone
- Prednisone
- Rofecoxib
- Rotavirus Vaccine
- Rubella Virus Vaccine Live
- Smallpox and Monkeypox Vaccine, Live, Nonreplicating
- Smallpox Vaccine, Vaccinia Vaccine
- Sulindac
- Tbo-Filgrastim
- Tolmetin
- Triamcinolone
- Tuberculin Purified Protein Derivative, PPD
- Typhoid Vaccine
- Valdecoxib
- Varicella-Zoster Virus Vaccine, Live
- Yellow Fever Vaccine, Live
