cladribine

(C) Vancouver General Hospital.
This monograph may not be reproduced without permission.
For further information, please contact a Pharmacist.

NAME OF DRUG
cladribine

CLASSIFICATION

Cytotoxic Agent- non-vesicant

ALTERNATE NAME

2-chlorodeoxy-adenosine, 2-CDA, LEUSTATIN

INDICATIONS

primary therapy of hairy cell leukemia
therapy of refractory chronic lymphocytic leukemia and related low grade non-Hodgkin's lymphomas

PHARMACOLOGY

exhibits its cytotoxic effect by inhibiting DNA synthesis
rapidly converted in malignant cells to active phosphorylated metabolite 2-CdATP
elimination half-life is approximately 14 hours
10-30% of total cladribine dose is renally excreted in the first 24 hours

RECONSTITUTION AND STABILITY

ALL cytotoxic drugs are prepared in pharmacy and will be sent to the ward with a label indicating storage conditions and the expiry date. All cytotoxic waste including bags, sets, tubing, gloves, etc. must be properly disposed of in the cytotoxic waste containers on the nursing unit.

COMPATIBILITY

compatible with NS only

ROUTES OF ADMINISTRATION

IV infusion - dilute in 100-1000 ml NS over 2-24 hours

VH & HSC ADMINISTRATION POLICY

A Parenteral Chemotherapy/Immunotherapy pre-printed order form (PPO # 45) must be used for prescribing if this cytotoxic agent
is not already on an existing PPO.

A - Not to be administered by direct IV route.
G - Cytotoxic Agents - see Drug Table G for specific administration guidelines.
H - The IV infusion rate must be controlled by an automated infusion control device.

DOSAGE

Hairy Cell Leukemia:

0.1 mg/kg/day (4 mg/m²/day) x 7 days via continuous IV infusion over 24 hours

Chronic Lymphocytic Leukemia:

0.12 mg/kg/day x 5 days IV over 2 hours

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

extravasation -see appendix VII for extravasation protocol for non-vesicants)
fever - patients should be maintained well hydrated during treatment

IMPORTANT IMPLICATIONS

bone marrow suppression, including neutropenia, anemia and thrombocytopenia is most notable within the first month following treatment; the patient's hematologic status must be monitored closely
mild neurologic toxicities, specifically paresthesia and dizziness, may rarely occur

VGH Site only:
Notify security-84 immediately upon accidental spillage.
DO NOT ATTEMPT CLEAN-UP

Reference: NEJM 1992; 327:1056-61

Rev. May 2006