Cladribine (Leustat®, LITAK®)
Cladribine is a chemotherapy drug that's usually given to treat hairy cell leukaemia and, more rarely, chronic lymphocytic leukaemia (CLL). This information should ideally be read with our general information about chemotherapy and your type of leukaemia.
You'll see your hospital doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
What cladribine looks like
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Cladribine is a powder that forms a colourless liquid when dissolved.
Hairy cell leukaemia
Cladribine can be given in a number of ways to treat hairy cell leukaemia.
It can be given as an injection just under the skin (subcutaneous injection). In this case, it's given daily for five days and you can have the treatment as an outpatient.
Cladribine can also be given as a drip (infusion) in one of the following ways:
through a fine tube inserted into a vein, usually in the back of your hand (cannula)
through a fine plastic tube inserted under the skin and into a vein near your collarbone (central line)
through a fine tube inserted into a vein in the crook of your arm (PICC line).
It's given as a continuous infusion for seven days. This may involve a short stay in hospital. Some people have the treatment given through a small portable pump attached to a central or PICC line, so they can have some of the treatment at home.
There are several different types of pump, but all are small enough to be carried on a belt or in a holster. Before you go home, your nurse should explain how to care for it and what to do if something goes wrong.
When the infusion is finished there may be some fluid left in the pump. This may be because some types of pump need to be overfilled to get the correct dose. You can check with your nurse or pharmacist whether you have this type of pump.
Chronic lymphocytic leukaemia
When cladribine is used to treat CLL, it's given by drip (infusion) for two hours each day, for five days. Each five-day course of treatment is known as a cycle. After the treatment you'll have a few weeks of rest before the next cycle is given. More than one cycle of treatment may be given.
Before you have your treatment, your doctor will arrange for you to have blood tests. You'll usually be given anti-sickness drugs before and/or during your treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here won't affect everyone who has cladribine, and may be different if you're having more than one type of chemotherapy drug.
We have outlined the most common side effects, but haven't included those that are very rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Cladribine can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38ºC (100.4ºF)
you suddenly feel unwell, even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising and bleeding
Cladribine can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
Cladribine can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) and being sick (vomiting)
This may begin soon after the treatment is given and can last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor - they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
A skin rash can sometimes occur while you're having treatment with cladribine. It’s important to let your doctor know if this happens. Your doctor can prescribe medicine to help with this.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t operate or drive machinery.
Constipation or diarrhoea
Cladribine can cause constipation or diarrhoea. Constipation can usually be helped by drinking plenty of fluids, through your diet and by engaging in gentle exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Diarrhoea can usually be easily controlled with medicine, but tell your doctor if it’s severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Some people find that cladribine causes headaches. Let your doctor know - they can give you painkillers to relieve this.
Some people may feel dizzy or light-headed. Tell your doctor if you have any of these side effects.
Pain in joints or muscles
This may be caused by cladribine. It's important to tell your doctor about this - they can prescribe painkillers to help.
Discomfort at injection site
Let your doctor or nurse know if you have any discomfort or change in sensation during or after the infusion.
Less common side effects
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Your liver and kidneys may be affected
Cladribine may cause changes in the way your liver and kidneys work. This is unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check how well your liver and kidneys are working (liver and kidney function tests). If your kidney function is lower than normal for your age, the dose of cladribine will be reduced.
Raised levels of uric acid in the blood
This can result in a condition called gout, which causes inflammation of the joints. To prevent this, you may be given a drug called allopurinol (Zyloric®), and you may be asked to drink plenty of fluids. While you're having cladribine you'll have regular blood tests to check your uric acid levels.
Effects on nervous system
Rarely, cladribine can effect your nervous system. If you notice a loss of sensation in your arms or legs, or feel confused or sleepy, it’s important to let your doctor know straight away.
Fever and chills
These may occur from the time that your treatment is given, but they don’t usually last long. Your doctor may prescribe medicines to reduce these effects.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having cladribine, as it may harm the developing baby. It’s important to use effective contraception while having this drug and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.Blood products
If you have treament with cladribine, for the rest of your life you should only be given blood transfusions and platelet transfusions that have been treated with radiation (irradiated).
This lowers the risk of the donated blood cells reacting against your own. Your hospital team should give you a card to carry or a Medicalert to wear so that hospital staff are aware in case of an emergency.
Very rarely, cladribine may cause a second cancer to develop years later. Your nurse or doctor can discuss this with you.
This section is based on our Cladribine factsheet which has been compiled using information from a number of reliable sources, including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed September 2011).
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott, Williams and Wilkins.