Care During Chemotherapy and Beyond
Cladribine is the generic name for the trade name drug LeustatinTM. In some cases, health care professionals may use the trade name Leustatin TM or other names 2-CdA or 2-chlorodeoxyadenosine when referring to the generic drug name cladribine.
Cladribine is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "antimetabolite." (For more detail,
see "How this drug works" section below).
What cladribine is used for:
Cladribine is used to treat:
Hairy cell leukemia
Acute myeloid leukemia (AML)
Chronic lymphocytic leukemia (CLL)
Langerhans cell histiocytosis
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 cladribine is given:
· Cladribine is administered by infusion through a vein. The infusion may be over 1-2 hours on consecutive days, or may be a continuous infusion over
several days. The way it is given depends on the protocol chosen by your physician.
There is no pill form of cladribine.
The amount of cladribine that you will receive depends on many factors, including your height and weight, your general health or other health problems,
and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.
Important things to remember about the side effects of cladribine:
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 will improve after therapy is complete.
Side effects may be quite manageable. There are many options to minimize or prevent the side effects of cladribine.
There is no relationship between the presence or severity of side effects and the effectiveness of the medication
Side effects of cladribine and their severity depend on how much of the drug is given. In other words, high doses may produce more severe side effects.
The following side effects are common (occurring in greater than 30%) for patients taking cladribine:
o Onset: None noted
o Nadir: 5-10 days (Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts)
o Recovery: 4-8 weeks
These are less common side effects (occurring in about 10-29%) of patients receiving cladribine:
Serious nerve toxicity has been reported in patients who received extremely high doses (4 to 9 times the recommended dose) of cladribine. This nerve has been rarely reported in patients receiving standard doses of
has been observed in patients who received extremely high doses (4 to 9 times the recommended dose) of cladribine, especially when given with other
medications known to cause kidney injury.
You will be considered immunosuppressed (increased risk of developing infection) for up to one year after taking cladribine.
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 or 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
Extreme fatigue (unable to carry on self-care activities)
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
Diarrhea (4-6 episodes in a 24-hour period)
Always inform your health care provider if you experience any unusual symptoms.
Before starting cladribine 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 cladribine.
Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (cladribine 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 get pregnant while taking cladribine. 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.
To reduce nausea, take anti-nausea medications as prescribed by your doctor, eat small amounts of food frequently.
Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
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.
Use an electric razor and a soft toothbrush to minimize bleeding.
Avoid contact sports or activities that could cause injury.
In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
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 while taking cladribine:
You will be checked regularly by your doctor while you are taking cladribine, 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
How cladribine 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.
Cladribine belongs to the class of chemotherapy drugs called antimetabolites. Antimetabolites are very similar to normal substances within the cell. When
the cells incorporate these substances into the cellular metabolism, they are unable to divide. Antimetabolites are cell-cycle specific. They attack cells
at very specific phases in the cycle. Antimetabolites are classified according to the substances with which they interfere. Cladribine interferes with the
enzyme adenosine deaminase.
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.
Cladribine.Lexicomp Online® [updated 2015 September 3; cited 2015 September 10, 2015].Lexi-Drugs®. Hudson, Ohio: Lexi-Comp, Inc.; September 10, 2015.
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