Leukeran

Indications

Chlorambucil is an oral anticancer medicine used to treat chronic lymphocytic leukaemia (CLL), some types of lymphoma including low grade non Hodgkin lymphoma and Hodgkin lymphoma, and Waldenström macroglobulinaemia. It is sometimes used for other conditions only under specialist care.

How It Works

Chlorambucil is an alkylating agent. It attaches chemical groups to the DNA of cells and links the DNA strands together, so the cells cannot copy their DNA or divide and they die. It acts mainly on fast growing cells such as cancerous white blood cells, but also affects healthy bone marrow.

Dosage and Administration

Take chlorambucil exactly as prescribed by a specialist. The dose depends on the illness, body weight and blood counts, and it may be taken daily for a period or in short courses with breaks. Swallow tablets whole with water, usually on an empty stomach, at least 1 hour before or 3 hours after food. Do not break or crush the tablets, and wash hands after handling them. Carers should avoid touching tablets with bare hands.

Interactions

• Other medicines that suppress the bone marrow, and radiotherapy, increase the risk of low blood counts.
• Live vaccines must not be given during treatment and for some time afterwards.
• Medicines that lower the seizure threshold may increase the risk of seizures, especially in children.
• Purine analogues such as Fludarabine, and Phenylbutazone, may increase toxicity.

Contraindications

• Allergy to chlorambucil.
• Severe bone marrow suppression not caused by the disease.
• Pregnancy and breastfeeding.
• Recent or planned live vaccination.

Side Effects

Common: low white cells, platelets and red cells, nausea, vomiting, diarrhoea and mouth ulcers. Less common or rare: skin rash, which can rarely become severe with blistering and peeling; seizures, particularly in children with kidney disease (nephrotic syndrome) or with high doses; liver problems; lung scarring; nerve problems; and reduced fertility. Long term use slightly increases the risk of later blood cancers such as acute leukaemia.

Get urgent medical help for fever of 38°C or more, chills, sore throat, unusual bleeding or bruising, a spreading or blistering rash, seizures, yellowing of the skin or eyes, or new breathlessness or cough.

Pregnancy and Lactation

Chlorambucil can cause birth defects. Both women and men must use effective contraception during treatment and for some months afterwards, as advised by the doctor. It must not be used while breastfeeding. It may cause permanent infertility; discuss fertility preservation before starting.

Precautions and Warnings

It should only be used under the supervision of a specialist. Blood counts are checked regularly, especially early in treatment. Use extra care in liver disease, a history of seizures or head injury, and in children with nephrotic syndrome. Avoid people with infections and report any sign of infection quickly. Handle tablets carefully and return unused tablets to the pharmacy.

Overdose

Overdose can cause severe low blood counts, seizures, agitation and unsteadiness. Seek emergency medical care; treatment in hospital is supportive, with blood count monitoring and transfusions if needed.

Therapeutic Class

Antineoplastic, alkylating agent (nitrogen mustard)

Storage

Store in a refrigerator at 2 to 8°C in the original container, or as directed on the pack. Keep out of the reach of children.