II. Indications
- FDA Approved
- Hairy Cell Leukemia
- Multiple Sclerosis (progressive, relapsing forms)
- Off-Label Use
- Acute Myelogenous Leukemia (adults and children)
- Advanced Cutaneous T Cell Lymphoma
- Autoimmune Hemolytic Anemia
- Chronic Lymphocytic Leukemia (CLL)
- Langerhans Cell Histiocytosis (children)
- Non-Hodgkin Lymphoma
- Sezary Syndrome
- Waldenstrom's Macroglobulinemia
III. Contraindications
- Active malignancy
- Moderate to severe Renal Insufficiency
- Moderate to severe hepatic insufficiency
- Acute infections
- Chronic Infections (exclude before administration)
IV. Mechanism
- Purine Nucleoside antimetabolite analog
- Cladribine is metabolized intracellularly to 2-CdATP (Cladribine triphosphate, an active metabolite)
- 2-CdATP incorporates into DNA
- Results in DNA single strand breaks
- Also depletes energy molecules
- Selectively more toxic to cancerous Lymphocytes and Monocytes
- Cladribine is resistant to Adenosine deaminase (therefore selective for Lymphocytes and Monocytes)
- Noncancerous Lymphocytes and Monocytes are less responsive to Cladribine
V. Medications
- Leustatin IV Solution: 10 mg per 10 ml vials (Hairy Cell Leukemia)
- Mavenclad oral tablets: 10 mg (Multiple Sclerosis)
VI. Dosing
- See other references for disease specific dosing protocols
VII. Adverse Effects
VIII. Safety
- Avoid in Pregnancy (any trimester)
- Men and women should use reliable Contraception for at least 6 months after last dose
- Avoid in Lactation
- Avoid Breast Feeding for at least 10 days after last dose
- Monitoring
- MRI Brain
- Risk of Progressive Multifocal Leukoencephalopathy
- Baseline within first 3 months of starting Cladribine
- Complete Blood Count
- Lymphocytes should be in normal range before first treatment
- Lymphocytes should be >800 cells/uL before second treatment (may required delayed course)
- Renal Function tests
- Liver Function Tests
- MRI Brain
IX. Drug Interactions
- Live attenuated Vaccinations
- Give all Live Vaccines at least 4 to 6 weeks before starting Cladribine
X. Resources
- Cladribine IV Solution (DailyMed)
- Mavenclad Oral Tablets (DailyMed)