Leukeran

Generic name: Chlorambucil

Drug Type:  Leukeran is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy  drug.  Leukeran is classified as an "alkylating agent."  (For more detail, see "How this drug works" section below).

What Leukeran Is Used For:

Used to treat chronic lymphocytic leukemia (CLL), Hodgkin's disease, non-Hodgkin's lymphoma, breast, ovarian and testicular cancer, Waldenstrom's macroglobulinemia, thrombocythemia, choriocarcinoma.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Leukeran Is Given:

• Leukeran is given by mouth as a coated tablet.
• Take 1 hour before or 2 hours after meals.
• The amount of Leukeran you receive and how often it is administered, depends on many factors, including your height and weight, your general health, any other health problems you may have, and the type of cancer or condition being treated.  Your doctor will determine your dose and schedule. 

Side Effects:

Important things to remember about the side effects of Leukeran:

• Most people do not experience all of the side effects listed.
• Side effects are often predictable in terms of their onset and duration.
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.
• There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%)for patients taking Leukeran:

• Low blood counts.  Your white and red blood cells and platelets may temporarily decrease.  This can put you at increased risk for infection, anemia and/or bleeding.
  
  Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

Onset: 7 days
Nadir: 14 days
Recovery: 28 days; may be prolonged to 6-8 weeks in some patients

These are less common side effects (occurring in 10-29%) for patients receiving Leukeran:

• Nausea and vomiting. 
• Skin rash (a severe skin reaction is a rare but serious side effect of Leukeran.  Promptly report any skin rashes or reactions to your health care provider).
• Increases in blood tests measuring liver function.  These return to normal once treatment is discontinued. (see liver problems).

The following side effects are rare for patients receiving Leukeran, discuss any concerns regarding these with your health care professional:

• Increased risk of developing a secondary malignancy such as an acute leukemia, with long-term use of this drug.
• Your fertility, meaning your ability to conceive or father a child, may be affected by Leukeran.  
• Pulmonary toxicity (damage to the lungs) has occurred in higher, long term (> 6 months) doses of Leukeran.  This is a relatively rare event.

Not all side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4°F (38° C) or higher, chills (possible signs of infection).

The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following:

• Skin rash
• Nausea (interferes with ability to eat and unrelieved with prescribed medication).
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools or urine
• Shortness of breath, persistent cough
• Yellowing of eyes or skin, change in color of stools or urine
• Extreme fatigue (unable to carry on self-care activities)

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting Leukeran treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking Leukeran.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Leukeran may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Do not conceive a child (get pregnant) while taking Leukeran. Barrier methods of contraception, such as condoms, are recommended.  Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking this medication

Self-Care Tips:

• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or salt mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• Avoid sun exposure.  Wear SPF 15 (or higher) sunblock and protective clothing.
• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
• Avoid acidic, spicy or hot foods  
• Get plenty of rest 
• Maintain good nutrition
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your doctor while you are taking Leukeran, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How Leukeran Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Leukeran is classified as an alkylating agent.  Alkylating agents are most active in the resting phase of the cell.  These drugs are cell cycle non-specific.  There are several types of alkylating agents.

• Mustard gas derivatives: Mechlorethamine, Cyclophosphamide, Leukeran, Melphalan, and Ifosfamide. 
• Ethylenimines:  Thiotepa and Hexamethylmelamine.
• Alkylsulfonates:  Busulfan.
• Hydrazines and Triazines: Altretamine, Procarbazine, Dacarbazine and Temozolomide. 
• Nitrosureas:  Carmustine, Lomustine and Streptozocin.  Nitrosureas are unique because, unlike most chemotherapy, they can cross the blood-brain barrier.  They can be useful in treating brain tumors.
• Metal salts:  Carboplatin, Cisplatin, and Oxaliplatin.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

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