Cladribine

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

  1. acute myelogenous leukemia (AML)
  2. chronic lymphocytic leukemia (CLL)
  3. cutaneous T-cell lymphoma (CTCL)
  4. hairy-cell leukemia
  5. multiple sclerosis
  6. mycosis fungoides
  7. 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

  1. abdominal pain
  2. alopecia
  3. anemia
  4. anorexia
  5. anuria
  6. anxiety
  7. aplastic anemia
  8. arthralgia
  9. asthenia
  10. back pain
  11. bleeding
  12. bone marrow suppression
  13. bone pain
  14. chest pain (unspecified)
  15. chills
  16. confusion
  17. conjunctivitis
  18. constipation
  19. cough
  20. depression
  21. diarrhea
  22. dizziness
  23. dyspnea
  24. ecchymosis
  25. edema
  26. elevated hepatic enzymes
  27. eosinophilia
  28. erythema
  29. fatigue
  30. fever
  31. fever
  32. flatulence
  33. graft-versus-host disease (GVHD)
  34. headache
  35. heart failure
  36. hemolytic anemia
  37. hepatitis
  38. hyperhidrosis
  39. hypertension
  40. infection
  41. infection
  42. injection site reaction
  43. insomnia
  44. lymphopenia
  45. maculopapular rash
  46. malaise
  47. myalgia
  48. nausea
  49. nephrotoxicity
  50. neurotoxicity
  51. neutropenia
  52. new primary malignancy
  53. pancytopenia
  54. peripheral edema
  55. peripheral neuropathy
  56. petechiae
  57. phlebitis
  58. pneumonitis
  59. progressive multifocal leukoencephalopathy
  60. pruritus
  61. pulmonary fibrosis
  62. purpura
  63. rash
  64. renal failure (unspecified)
  65. seizures
  66. sinus tachycardia
  67. Stevens-Johnson syndrome
  68. teratogenesis
  69. thrombocytopenia
  70. toxic epidermal necrolysis
  71. tumor lysis syndrome (TLS)
  72. urticaria
  73. vomiting
  74. weakness
  75. 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
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