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2-chlorodeoxyadenosine (2-CdA) [cladribine] (Leustatin)
Alias: cladribine. Tradename: Leustatin.
Indications:
1) hairy cell leukemia
2) B-cell chronic lymphocytic leukemia resistant to fludarabine
3) follicular lymphoma
4) Langerhans cell histiocytosis [4]
5) Waldenstrom's macroglobulinemia [4]
Dosage:
1) Adults: 0.09-0.1 mg/kg/day continuous infusion for 7 consecutive days
2) prophylactic allopurinol should be considered because of potential for tumor lysis syndrome
Vials: 1 mg/mL, 10 mL.
Monitor: CBC especially during 1st 4-8 weeks post-treatment
Adverse effects:
1) common (> 10%)
a) fatigue
b) rash
c) injection site reactions
d) headache
e) bone marrow suppression
- platelet counts decrease in 1st 1 weeks & normalize by day 12
- neutrophil count declines but normalize by week 5
- hemoglobin declines but normalizes by week 6
f) fever
- 66% within 1st month
- < 33% of febrile events associated with documented infection
g) gastrointestinal
- decreased appetite
- nausea/vomiting
- diarrhea
2) less common (1-10%)
- edema, tachycardia, pruritus, pain, erythema, dizziness, insomnia, myalgia/arthralgia, constipation, abdominal pain, chills, asthenia, diaphoresis, malaise, trunk pain
Drug interactions:
- glucocorticoids potentiate defects in cell-mediated immunity long after treatment with cladrabine [5]
General
antineoplastic agent (chemotherapeutic agent)
purine antimetabolite; antimetabolite; purine analog
References
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 529
- Department of Veterans Affairs, VA National Formulary
- Deprecated Reference
- Dagogo-Jack I, Vaidya A, Geller B, Baden LR, Stone R.
A Man with Fever, Cough and Rash
N Engl J Med 2014 371:e11. August 21, 2014
PMID: 25140977
http://www.nejm.org/doi/full/10.1056/NEJMimc1310796
Databases & Figures
PUBCHEM correlations
Therapeutic Inducers of Apoptosis