• Chronic Lymphocytic Leukemia (CLL)

Dose:

  • initial dose: 0.2–0.4 mg/kg daily (commonly 4–6 mg daily)
  • Maintenance dose: 2–6 mg daily depending on response and toxicity
  • Alternatives: Intermittent courses, e.g., 12 mg/day for 7 days repeated every 4–6 weeks for some patients
  • Hodgkin’s lymphoma (as part of combination therapy)
  • Non-Hodgkin lymphoma

Dose:Dosage depends on regimen, typically 4–6 mg daily for 3–4 weeks, then adjust based on response

  • Waldenström’s Macroglobulinemia
  • Autoimmune diseases (e.g., severe rheumatoid arthritis, lupus)

Dose: Rheumatoid arthritis: 0.1–0.2 mg/kg daily (usually low doses),Systemic lupus erythematosus (SLE) and other conditions may use 2–4 mg daily based on severity

  • PO: 2 mg, 5 mg, 10 mg
  • Oral administration, with or without food
  • Follow-up with regular blood work (e.g., CBC) to monitor for myelosuppression
  • Hydration to reduce risk of renal toxicity (especially with higher doses)
  • Avoid live vaccines during treatment
  • Class: Alkylating agent (nitrogen mustard derivative)
  • Mechanism of Action:
    • Prodrug → converted to active form (phosphoramide mustard) → crosslinks DNA → inhibits replication and transcription → induces apoptosis of cancer or autoimmune cells
    • Cell cycle non-specific
    • Immunosuppressive properties
  • Half-life: ~1–2 hours (short)
  • Excretion: Primarily via urine
  • Nausea, vomiting
  • Anorexia
  • Fatigue
  • Bone marrow suppression (neutropenia, thrombocytopenia, anemia)
  • Alopecia (hair loss, generally reversible)
  • Mucosal irritation (e.g., oral ulcers)
  • Hypersensitivity to chlorambucil or its components
  • Severe bone marrow suppression
  • Severe hepatic impairment
  • Pregnancy (category D)
    • Live vaccines: Risk of infection due to immunosuppression
    • Other cytotoxic agents: Additive toxicity (e.g., myelosuppression, hepatotoxicity)
    • Hepatotoxic drugs: May increase the risk of liver injury
  • Corticosteroids: May increase the risk of infections or gastrointestinal issues when combined

                                   Drug Status

Availability
Pregnancy
Breastfeeding
Schedule
BRAND NAME STRENGTH FORMULATION PACK SIZE MANUFACTURER DISTRIBUTOR
Leukeran 2mg Tablet 25’s Beta Healthcare Beta Healthcare