Cladribine

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Drug information

Synonyms: CdA, 2-CdA, 2-chloro-2'-deoxyadenosine

Indications

Hairy Cell Leukemia

There are basically two types of regimens, intermittent and continuous infusions.

Continuous infusions include:

1. 0.087 mg or 0.1 mg/kg/day CI over 7 days (Save et al Blood 1998; 92:1918)

2. 4 mg/sqm/day CI for 7 days (Estey et al Blood 1992; 79:882)

Intermittent schedules include:

1. 0.14 mg/kg/day (by 2-hour infusion) either for 5 consecutive days or once a week at 0.14 mg/kg for 5 cycles (Zinzani et al. Haematologica 2004;89:309-313

The British guidelines (http://www.bcshguidelines.com/pdf/CHPT3C.pdf) recommends the continuous infusion schedules at 0.1 mg/kg/day for 7 days and repeat at 6 months if no CR; About intermittent schedules, it states that regimens such as once per week for 5–7 weeks, or 5 mg/m2/day for 5 days as a 1–2 hour infusion, or 0.15 mg/kg by infusions over 2–5 hours have been used elsewhere, with good response rates. However, it cautions that no comparisons have been made between the week-long and shorter duration infusions, and therefore there is no information about the durability of responses and EFS with the latter regimens.

Some have found the intermittent regimens are convenient and patient friendly.

Regarding GCSF, the guidelines state that "Growth factors, e.g. G-CSF, could also be used to treat severe neutropenia (< 0.5 x 109/l) before, during and/or after the use of either pentostatin or cladribine." Septran (Bactrim) is recommended as prophylaxis for PCP after completion of treatment; blood products should be irradiated to prevent TaGVHD.

Another option is to treat with interferon till the counts improve and then add cladribine or pentostatin

Stringer et al A New Name (Pneumocystis jiroveci) for Pneumocystis from Humans. Emerging Infectious diseases Sept 2002;volume 8. Access at http://www.cdc.gov/ncidod/EID/vol8no9/02-0096.htm.

References

Chadha P et al. Treatment of hairy cell leukemia with 2-chlorodeoxyadenosine (2-CdA): long-term follow-up of the Northwestern University experience. Blood 2005; 106:241

Chronic Lymphocytic Leukemia

  • 0.1 mg/kg/d civi d1-7

Q4-5w

References