2-chlorodeoxyadenosine (2-CdA) [cladribine] (Leustatin)

Introduction

Alias: cladribine. Tradename: Leustatin.

Indications

• hairy cell leukemia
• B-cell chronic lymphocytic leukemia resistant to fludarabine
• follicular lymphoma
• Langerhans cell histiocytosis
• Waldenstrom's macroglobulinemia

Dosage

• Adults: 0.09-0.1 mg/kg/day continuous infusion for 7 consecutive days
• 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

• common (> 10%)
  • fatigue
  • rash
  • injection site reactions
  • headache
  • 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
  • fever
    • 66% within 1st month
    • < 33% of febrile events associated with documented infection
  • gastrointestinal
    • decreased appetite
    • nausea/vomiting
    • diarrhea
• 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

More general terms

• purine antimetabolite; antimetabolite; purine analog
• antineoplastic agent (chemotherapeutic agent)

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=20279
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=1546