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Cladribine

Adenosine 2 Chloro 2' Deoxy


Presentation

  • Splenomegaly was present in 93.5% of cases at diagnosis. The laboratory findings that came into prominence were pancytopenia with grade 3 bone marrow fibrosis.[ncbi.nlm.nih.gov]
  • These cells also showed the expression of CD19, CD20, CD23 and CD5 antigens similar to those presented on PB lymphocytes.[ncbi.nlm.nih.gov]
  • The clinical presentation can be heterogeneous, from a single bone lesion to potentially fatal, widespread disease.[ncbi.nlm.nih.gov]
  • We present a case report of development of unilateral gynecomastia in a case of hairy cell leukaemia treated with cladribine and question whether this was induced by the chemotherapy.[ncbi.nlm.nih.gov]
  • A 45-year-old man with "hand-shoulder" syndrome developing eight-months after Cladribine-induced remission of an 11-year-old hairy cell leukosis is presented.[ncbi.nlm.nih.gov]
Intravenous Drugs
  • Solutions containing LEUSTATIN Injection should not be mixed with other intravenous drugs or additives or infused simultaneously via a common intravenous line, since compatibility testing has not been performed.[globalrph.com]
  • Do not mix solutions containing cladribine with other intravenous drugs or additives or infuse simultaneously via a common intravenous line, as compatibility testing has not been performed.[pdr.net]
Intravenous Administration
  • Cladribine plasma concentration after intravenous administration declines multi-exponentially with an average half-life of 6.7 /- 2.5 hours.[globalrph.com]
  • Intravenous Administration CAUTION: Observe and exercise usual cautions for handling and preparing solutions of cytotoxic drugs.[pdr.net]
Constitutional Symptom
  • We report a patient with B-CLL Rai II, with multiple nodular skin infiltrations on the trunk, upper arms and thighs as well as constitutional symptoms, who was successfully treated with cladribine.[ncbi.nlm.nih.gov]
Weight Gain
  • Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain. Shortness of breath. Very loose stools (diarrhea). Very upset stomach or throwing up. Feeling very tired or weak.[mskcc.org]
Peripheral Neuropathy
  • Although, severe neurologic toxicity appears to be dose related, rarely severe neurotoxicity, axonal peripheral neuropathy, has been reported following standard dose cladribine therapy.[pdr.net]
  • Cladribine has also been reported to have been used to treat a single patient suffering from IgM associated inflammatory peripheral neuropathy that, unlike MS and NMO, is a non-relapsing, non-remitting disease.[google.com]
  • In contrast, Vahdat and colleagues at the Memorial Sloan-Kettering Cancer Center reported that sensorimotor peripheral neuropathy was dose-limiting non-hematologic toxicity in a dose escalation study in patients with acute myeloid leukemia, excluding[academic.oup.com]
  • neuropathy after completing 2 courses of low-dose cladribine (0.1 mg/kg per day 2-hour infusion for 7 days). 119 In addition, at very elevated doses (more than triple the approved dose), a delayed severe motor weakness developed. 120 Future research[bloodjournal.org]

Workup

Bicytopenia
  • Although the patient responded to the treatment, the relapse with splenomegaly and bicytopenia was observed after 10 months.[ncbi.nlm.nih.gov]
  • Here we reported a 48-year-old men who was found to have splenomegaly and bicytopenia incidentally at routine physical checkup.[ncbi.nlm.nih.gov]
Amyloid Plaque
  • Remarkably, chronic treatment of APdE9 mice, a model of Alzheimer's disease with 2-CDA for 60 days increased amyloid plaque burden by more than 1-fold.[ncbi.nlm.nih.gov]

Treatment

  • […] as the most efficient licensed treatments.[ncbi.nlm.nih.gov]
  • Current National Comprehensive Cancer Network (NCCN) treatment guidelines include rituximab (R) plus cladribine for the initial treatment of MCL. However, few data are available to substantiate this recommendation.[ncbi.nlm.nih.gov]
  • Cladribine was used as the first-line treatment in 9 patients and as later-line treatment in the remaining 12 patients. The median number of cycles of cladribine administered was 2.5 (range, 1-6).[ncbi.nlm.nih.gov]
  • Most of the patients with an indication for treatment were treated with cladribine as first-line treatment. Total and complete response of cladribine was 97.3% and 80.7%.[ncbi.nlm.nih.gov]
  • One patient had an aggressive, early relapsing disease requiring further treatment lines. The treatment-related toxicities consisted of transient bone marrow suppression affecting the leukocytes predominantly.[ncbi.nlm.nih.gov]

Prognosis

  • Histiocytic sarcoma, a rare hematopoietic neoplasm with evidence of histiocytic differentiation, is often refractory to conventional chemotherapy and radiotherapy, and its prognosis is generally dismal.[ncbi.nlm.nih.gov]
  • Rosai-Dorfman disease (RDD) is a rare disorder, often benign but with possible life-threatening prognosis.[ncbi.nlm.nih.gov]
  • Worldwide, lung cancer is the most common form of cancer and often has a poor prognosis. Establishment of effective therapies for lung cancer is a major concern in clinical cancer research.[ncbi.nlm.nih.gov]
  • Cutaneous presentation of B-cell chronic lymphocytic leukaemia (B-CLL) is uncommon, and the influence of skin changes on B-CLL prognosis is unclear.[ncbi.nlm.nih.gov]
  • Treatment decisions must still be based on particular differences within individual MS heterophenotypes, including activity, severity and putative prognosis, rather than automatically opting for an immune-resetting therapy, as these therapies still carry[nature.com]

Etiology

  • […] the rate of neoplasms, both malignant and benign, was similar but numerically slightly higher for the 3.5-mg drug group than the placebo group (1.14 and 1.01), the researchers said, adding that there was "no clustering of malignancies with a common etiology[medpagetoday.com]
  • Respiratory, thoracic and mediastinal disorders: Pulmonary interstitial infiltrates (including lung infiltration, interstitial lung disease, pneumonitis and pulmonary fibrosis ); in most cases, an infectious etiology was identified.[rxlist.com]
  • In view of the known toxicities of agents of this class, it would be prudent to proceed carefully in patients with known or suspected renal insufficiency or severe bone marrow impairment of any etiology.[globalrph.com]

Epidemiology

  • . · Category Pharmacology Cladribine is a small molecule that may interfere with the behaviour and the proliferation of certain white blood cells, particularly lymphocytes, thought to be involved in the pathological process of MS Epidemiology NICE estimate[sps.nhs.uk]
  • […] combination did report a statistical increase in lung cancer incidence among cladribine-based therapy, but the authors made no definitive conclusions. 110 A comparison of purine analog-treated patients to an age-adjusted population from the Surveillance, Epidemiology[bloodjournal.org]
  • We presented three very different cases of HCL in very old patients diagnosed in a single center and discussed some epidemiological and therapeutical issues in such patients.[cancerindex.org]
Sex distribution
Age distribution

Pathophysiology

  • Immunotherapeutic approaches in MS: update on pathophysiology and emerging agents or strategies 2006. Endocr Metab Immune Disord Drug Targets 2007 ;7: 35 - 63 4. Cohen BA, Rieckmann P. Emerging oral therapies for multiple sclerosis.[nejm.org]

Prevention

  • Wash your hands well to prevent the spread of infections. To lower your risk of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports.[webmd.com]
  • Patients were administered oral trimethoprim/sulfamethoxazole and valaciclovir to prevent opportunistic infections. They gave written consent to receive off-label cladribine in the absence of validated treatment.[ncbi.nlm.nih.gov]
  • Tips to preventing infection: Washing hands , both yours and your visitors, is the best way to prevent the spread of infection.[oncolink.org]
  • Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.[macmillan.org.uk]

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