Cladribine (Adenosine 2 Chloro 2' Deoxy)

Cladribine[1]

Presentation

psychiatrical
Withdrawn
  • […] activities of Cladribine.ApprovedAcetyldigoxinAcetyldigoxin may decrease the cardiotoxic activities of Cladribine.Experimental Ancestim The risk or severity of cytotoxicity can be increased when Ancestim is combined with Cladribine.Approved, Investigational, Withdrawn[drugbank.ca]
  • Feb 11: EU filing withdrawn [21]. · 17.[sps.nhs.uk]
  • Cladribine, an oral treatment for relapsing remitting MS, previously approved in Australia, but subsequently withdrawn, is making a comeback.[msra.org.au]
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  • gastrointestinal
    Flatulence
    • Disturbances of the gut such as abdominal pain, constipation, diarrhoea, flatulence (wind). Dizziness. Confusion. Anxiety. Difficulty sleeping (insomnia). Skin reactions such as hives, rash, sweating or itching. Eye inflammation (conjunctivitis).[netdoctor.co.uk]
    • Nervous System Disorders Dizziness 6 Headache 14 Cardiac Disorders Tachycardia 2 Respiratory, Thoracic and Mediastinal Disorders Breath sounds abnormal 4 Cough 7 Dyspnea* 5 Rales 1 Gastrointestinal Disorders Abdominal pain** 4 Constipation 4 Diarrhea 7 Flatulence[rxlist.com]
    • Early / 5.0-5.0 abdominal pain / Early / 4.0-4.0 arthralgia / Delayed / 3.0-3.0 hyperhidrosis / Delayed / 3.0-3.0 insomnia / Early / 3.0-3.0 chills / Rapid / 2.0-2.0 pruritus / Rapid / 2.0-2.0 petechiae / Delayed / 2.0-2.0 ecchymosis / Delayed / 2.0-2.0 flatulence[pdr.net]
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  • neurologic
    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]
    • […] to 15% of patients. 117 This risk is not thought to be high because cladribine has been successfully applied to the treatment of multiple sclerosis. 118 One patient with a preexisting paraneoplastic syndrome died of a rapidly progressive sensorimotor peripheral[bloodjournal.org]
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  • Entire body system
    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]
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  • Fetus
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  • Workup

    Laboratory

    Serum
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  • Treatment

    Prognosis

    Complications

    Thrombocytopenia
    • Adverse Reactions: Severe myelosuppression (eg, neutropenia, anemia, thrombocytopenia), fever, infection, fatigue, nausea, rash, headache, inj site reactions, others; neurotoxicity, nephrotoxicity, tumor lysis syndrome (rare). Elimination: Renal.[cancertherapyadvisor.com]
    • Severe bone marrow suppression, including neutropenia, thrombocytopenia, and anemia, should be anticipated during cladribine therapy. This is usually reversible and dose dependent.[pdr.net]
    • Severe anemia (Hemoglobin 8.5 g/dL) developed in 37% of patients, compared with 10% initially and thrombocytopenia (Platelets 20 x 10 9 /L) developed in 12% of patients, compared to 4% in whom it was noted initially.[rxlist.com]
    • Hematologic: Myelosuppression (neutropenia) , anemia, thrombocytopenia. Metabolic: Fever. CNS: Headache, dizziness. Urogenital: Elevated serum creatinine.[robholland.com]
    • Dose-limiting toxicities included marked leukopenia and thrombocytopenia at doses more than 0.15 mg/kg per day.[bloodjournal.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]
    • […] to 15% of patients. 117 This risk is not thought to be high because cladribine has been successfully applied to the treatment of multiple sclerosis. 118 One patient with a preexisting paraneoplastic syndrome died of a rapidly progressive sensorimotor peripheral[bloodjournal.org]
    Pancytopenia
    • CASE 2 A 35 year old woman was diagnosed with SLE at age 31, with fever, pancytopenia, and nephrotic syndrome (proteinuria 6.65 g/24 h). ANA and anti-dsDNA antibodies were present. Renal biopsy revealed WHO Class III lupus nephritis.[ard.bmj.com]
    • Blood and lymphatic system disorders: Bone marrow suppression with prolonged pancytopenia , including some reports of aplastic anemia; hemolytic anemia (including autoimmune hemolytic anemia ), which was reported in patients with lymphoid malignancies[rxlist.com]
    • Decreased peripheral blood counts in all cell lines, including pancytopenia, have been reported in Rebif-treated patients.[media.emdserono.com]
    • Severe neutropenia (as rated by the investigators) was reported in three patients receiving cladribine (one in the 3.5-mg group and two in the 5.25-mg group), with severe thrombocytopenia and pancytopenia in one of the patients in the latter group, who[nejm.org]
    • The laboratory findings that came into prominence were pancytopenia with grade 3 bone marrow fibrosis. Most of the patients with an indication for treatment were treated with cladribine as first-line treatment.[cancerindex.org]
    Myelosuppression
    • Increased toxicity with myelosuppressive, immunosuppressive, or nephrotoxic agents. Pharmacological Class: Chlorinated purine nucleoside analog.[cancertherapyadvisor.com]
    • Many patients receiving treatment with cladribine have myelosuppression at the initiation of therapy due to their disease. Myelosuppression will worsen following cladribine therapy, before recovering.[pdr.net]
    • Hematologic: Myelosuppression (neutropenia) , anemia, thrombocytopenia. Metabolic: Fever. CNS: Headache, dizziness. Urogenital: Elevated serum creatinine.[robholland.com]
    • […] activities of Lipegfilgrastim.Approved, Investigational Metamizole The risk or severity of myelosuppression can be increased when Metamizole is combined with Cladribine.Approved, Investigational, WithdrawnMetildigoxinMetildigoxin may decrease the cardiotoxic[drugbank.ca]
    • Side effects The most common side effect from taking cladribine is low blood counts, referred to as myelosuppression .[encyclopedia.com]
    Septic Shock
    • shock ; about 40% of people taking the drug had fewer red blood cells and became severely anemic ; and about 10% of people had too few platelets . [6] At the dosage used to treat HCL in two clinical trials, 16% of people had rashes and 22% had nausea[en.wikipedia.org]
    • These adverse reactions have been reported primarily in patients who received multiple courses of LEUSTATIN Injection: Infections and infestations: Septic shock. Opportunistic infections have occurred in the acute phase of treatment.[rxlist.com]
    Shock
    • Vaak (1-10%): septische shock, pneumonie, bacteriëmie, cellulitis, plaatselijke infectie. Febriele neutropenie, hemolytische anemie. Verwarring (o.a. desoriëntatie), slapeloosheid, angst. Duizeligheid. Conjunctivitis. Flebitis.[farmacotherapeutischkompas.nl]
    • […] suppresses the body's ability to make new blood cells (called Myelosuppression ); data from HCL studies showed that about 70% of people taking the drug had fewer white blood cells and about 30% developed infections and some of those progressed to septic shock[en.wikipedia.org]
    • These adverse reactions have been reported primarily in patients who received multiple courses of LEUSTATIN Injection: Infections and infestations: Septic shock. Opportunistic infections have occurred in the acute phase of treatment.[rxlist.com]
    Langerhans-Cell Histiocytosis
    • "Langerhans cell histiocytosis in children: from the bench to bedside for an updated therapy". Br J Haematol . 173 (5): 663–70. doi : 10.1111/bjh.13955 . PMID 26913480 .[en.wikipedia.org]
    • What Cladribine Is Used For: Cladribine is used to treat: Hairy cell leukemia Acute myeloid leukemia (AML) Chronic lymphocytic leukemia (CLL) Langerhans cell histiocytosis Non-Hodgkin's lymphomas Waldenstrom macroglobulinemia Note: If a drug has been[chemocare.com]
    • Spontaneous remission of 2-chlorodeoxyadenosine (2-CdA)-related secondary myelodysplastic syndrome in a patient with refractory Langerhans cell histiocytosis.[cancerindex.org]
    • Miscellaneous conditions Cladribine has also been reported to have activity in a number of much less common hematologic neoplasms, including Langerhans cell histiocytosis, 98 systemic mastocytosis, 99 hypereosinophilic syndromes, 100 myelofibrosis and[bloodjournal.org]
    Prolymphocytic Leukemia
    • "Epigenetic therapy overcomes treatment resistance in T cell prolymphocytic leukemia" . Science Translational Medicine . 7 (293): 293ra102–293ra102. doi : 10.1126/scitranslmed.aaa5079 . ISSN 1946-6234 . PMC 4807901 . PMID 26109102 .[en.wikipedia.org]
    • The disease, drug-resistant T-cell prolymphocytic leukemia (T-PLL) is commonly fatal. But the blood cancer was re-sensitized to treatment when patients were given the Scripps-developed drug, cladribine , according to the study.[sandiegouniontribune.com]
    • Abbreviations Abbreviations 2-CdA cladribine (2-chlorodeoxyadenosine) HCL hairy cell leukemia CLL chronic lymphocytic leukemia PLL prolymphocytic leukemia B-CLL B-chronic lymphocytic leukemia B-PLL B-prolymphocytic leukemia CTCL cutaneous T-cell lymphoma[academic.oup.com]
    • […] activity in a number of much less common hematologic neoplasms, including Langerhans cell histiocytosis, 98 systemic mastocytosis, 99 hypereosinophilic syndromes, 100 myelofibrosis and myeloid metaplasia, 101 cutanenous T-cell lymphoma, 102 and B-cell prolymphocytic[bloodjournal.org]
    Waldenstrom Macroglobulinemia
    • What Cladribine Is Used For: Cladribine is used to treat: Hairy cell leukemia Acute myeloid leukemia (AML) Chronic lymphocytic leukemia (CLL) Langerhans cell histiocytosis Non-Hodgkin's lymphomas Waldenstrom macroglobulinemia Note: If a drug has been[chemocare.com]
    • These patients' illnesses were FL (n   21), nodal marginal zone B cell lymphoma (NMZB, n   3), MCL (n   3), splenic marginal zone B cell lymphoma (n   2), hairy cell leukemia (n   1), Waldenstrom macroglobulinemia (WM, n   1), and lymphoplasmacytic lymphoma[cancerindex.org]

    Etiology

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

    Prevention

    Summary

    Patient Information

    Other symptoms

    Mantle Cell Lymphoma
    • Phase I trial of rituximab, cladribine, and temsirolimus (RCT) for initial therapy of mantle cell lymphoma.[cancerindex.org]
    • One of the two patients with mantle cell lymphoma attained PR by three courses. One patient with B-CLL attained PR by a single course. One patient with ATL of acute type (Case 5) achieved PR after three courses of 2-CdA.[academic.oup.com]
    • Mantle cell lymphoma (MCL) has fewer, and generally unsatisfactory, available treatments. Standard curative therapies do not exist for any of the indolent lymphomas, and additional treatment options are needed.[bloodjournal.org]
    B-Cell Prolymphocytic Leukemia
    • prolymphocytic leukemia to 2-chlorodeoxyadenosine [Letter] , J Clin Oncol , 1992 , vol. 10 pg. 1821 12 2-Chlorodeoxyadesine treatment of low-grade lymphomas , J Clin Oncol , 1992 , vol. 10 (pg. 371 - 7 ) 13 2-Chlorodeoxyadenosine is an active salvage[academic.oup.com]
    • prolymphocytic leukemia. 77 , 103 Cladribine toxicities Cytopenias Myelosuppression is cladribine's principal toxicity ( Table 9 ). 42 , 85 , 86 , 88 Patients with CLL and indolent lymphoma experience similar rates and grades of neutropenia, thrombocytopenia[bloodjournal.org]
    Erdheim-Chester Disease
    • Page accessed January 14, 2015 Histiocytosis Association Erdheim-Chester Disease Page accessed Aug 20, 2016 Aricò M (2016). "Langerhans cell histiocytosis in children: from the bench to bedside for an updated therapy".[en.wikipedia.org]
    Immunosuppressive Drug
    • To our knowledge, this is the first report of 2-CdA-related MDS with spontaneous hematological remission. 2-Chlorodeoxyadenosine (cladribine, CdA) is an immunosuppressive drug that is licensed to treat hairy cell leukaemia, and has been shown recently[cancerindex.org]
    B-Cell Lymphoma
    • These patients' illnesses were FL (n   21), nodal marginal zone B cell lymphoma (NMZB, n   3), MCL (n   3), splenic marginal zone B cell lymphoma (n   2), hairy cell leukemia (n   1), Waldenstrom macroglobulinemia (WM, n   1), and lymphoplasmacytic lymphoma[cancerindex.org]

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    References

    1. A Double‐Blind, Placebo‐Controlled, Randomized Trial of Cladribine in Relpaasing‐Remitting Multiple Sclerosis - JS Romine, JC Sipe, JA Koziol, J Zyroff - Proceedings of the , 2003 - Wiley Online Library
    2. 2-Chlorodeoxyadenosine (Cladribine) in the treatment of patients with chronic lymphocytic leukemia 55 years old and younger. - T Robak, JZ Błoński, H Urbańska-Ryś - : official journal of the , 1999 - ukpmc.ac.uk
    3. Activity of 2-chlorodeoxyadenosine (Cladribine) in 2-hour intravenous infusion in 94 previously treated patients with low grade non-Hodgkin's lymphoma - T Robak, J Gora-Tybor, E Krykowski - Leukemia & , 1997 - informahealthcare.com
    4. A review of multiple sclerosis with Asian perspective - HT Chong, CT Tan - Med J Malaysia, 2008 - myjurnal.um.edu.my
    5. Cladribine combined with cyclophosphamide and mitoxantrone is an active salvage therapy in advanced non-Hodgkin's lymphoma - T Robak, E Lech-Maranda, A Janus - Leukemia & , 2007 - informahealthcare.com
    6. Acute myeloid leukemia following treatment with cladribine for hairy cell leukemia: A case report and review of the literature - R Hassan, M Gupta, W Kern - Leukemia & lymphoma, 2004 - informahealthcare.com
    7. 2‐Chlorodeoxyadenosine (cladribine) in the treatment of hairy cell leukemia and hairy cell leukemia variant: 7‐year experience in Poland - T Robak, M Błasińska‐Morawiec - European journal of , 1999 - Wiley Online Library
    8. Activity of 2-chlorodeoxyadenosine (Cladribine) in 2-hour intravenous infusion in 94 previously treated patients with low grade non-Hodgkin's lymphoma - T Robak, J Gora-Tybor, E Krykowski - Leukemia & , 1997 - informahealthcare.com
    9. Anaesthesia and anti-cancer chemotherapeutic drugs - E Huettemann, SG Sakka - Current Opinion in Anesthesiology, 2005 - journals.lww.com
    10. 21 Chemotherapy-Induced Renal and Electrolyte Dysfunction - GF RATE - Perry's The Chemotherapy Source Book, 2012 - books.google.com
    11. A phase I study of intermittent infusion cladribine in patients with solid tumors - K Kobayashi, NJ Vogelzang, SM O'Brien, RL Schilsky - Cancer, 1994 - Wiley Online Library

    Media References

    1. Cladribine, Public Domain

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