CLADRIBINE
(cla'dri-been)
Leustatin
Classifications: antineoplastic; antimetabolite, purine antagonist
Prototype: 6-mercaptopurine
Pregnancy Category: D

Availability

1 mg/mL injection

Actions

Cladribine is a synthetic antineoplastic agent with selective toxicity toward certain normal and malignant lymphocytes and monocytes. It accumulates intracellularly, preventing repair of single-stranded DNA breaks and ultimately interfering with cellular metabolism and DNA synthesis.

Therapeutic Effects

Cladribine is cytotoxic to both actively dividing and quiescent lymphocytes and monocytes, inhibiting both DNA synthesis and repair.

Uses

Treatment of hairy cell leukemia.

Unlabeled Uses

Advanced cutaneous T-cell lymphomas, chronic lymphocytic leukemia, non-Hodgkin's lymphomas, acute myeloid leukemia, autoimmune hemolytic anemia, mycosis fungoides.

Contraindications

Hypersensitivity to cladribine; pregnancy (category D).

Cautious Use

Hepatic or renal impairment. Safety and efficacy in children not established.

Route & Dosage

Hairy Cell Leukemia
Adult: IV 0.09 mg/kg/d by 7 d continuous infusion

Chronic Lymphocytic Leukemia
Adult: IV 0.1 mg/kg/d by 7 d continuous infusion or 0.028–0.14 mg/kg/d as 2 h infusion for 5 consecutive d

Administration

Solutions for cladribine should not be mixed with any other IV drugs or additives, nor administered through an IV line used for other drugs or solutions.
Use disposable gloves and protective clothing when handling the drug.
Wash immediately if skin contact occurs.

Intravenous

PREPARE: IV Infusion (single daily dose): IV infusion (7-day dose): The calculated dose of cladribine is injected into an infusion reservoir using a 0.22 micron filter. An amount of bacteriostatic NS is added through a 0.22 micron filter to bring the total to 100 mL. (Note: reservoir usually prepared by the pharmacist.)

ADMINISTER: IV Infusion (single daily dose): Distribute evenly over ordered time (i.e., 2 h or 24 h). IV infusion (7-day dose): Give through a central line and control by a pump device (e.g., Deltec pump) to deliver 100 mL evenly over 7 d.

INCOMPATIBILITIES Solution/additive: Do not mix with any other diluents or drugs.

Diluted solutions of cladribine may be stored refrigerated for up to 8 h prior to administration.
Store unopened vials in refrigerator (2°–8° C/36°–46° F), and protect from light.

Adverse Effects (1%)

CNS: Headache, dizziness. GI: Nausea, diarrhea. Hematologic: Myelosuppression (neutropenia), anemia, thrombocytopenia. Metabolic: Fever. CNS: Headache, dizziness. Urogenital: Elevated serum creatinine.

Interactions

Drug: Additive risk of bleeding with anticoagulants, nsaids, platelet inhibitors, salicylates.

Pharmacokinetics

Onset: Therapeutic effect 10 d to 4 mo. Duration: 7–25+ mo. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In malignant leukocytes, cladribine is phosphorylated to form its monophosphate and triphosphate forms, presumably its active forms, which are subsequently incorporated into cellular DNA. Half-Life: Initial 35 min, terminal 6.7 h.

Nursing Implications

Assessment & Drug Effects

Monitor vital signs during and after drug infusion. Fever (>100° F) is common during the 5th to 7th day in patients with hairy cell leukemia, and severe fever (>104° F) may develop within the first month of therapy.
Lab tests: Frequent hematologic studies; periodic serum creatinine and liver function tests.
Closely monitor hematologic status; myelosuppression is common during the first month after starting therapy.
Monitor for and report S&S of infection. Note that within the first month, fever may occur in the absence of infection.
With high doses of cladribine, monitor for neurologic toxicity (paraparesis/quadriparesis) and acute nephrotoxicity.

Patient & Family Education

Be fully informed regarding adverse responses to the drug.
Understand the need for close follow-up during and after treatment with the drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug