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How it is administered
Cladribine is typically administered as an intravenous (IV) infusion. The recommended dose for blood cancers like Hairy Cell Leukemia is 0.09 mg/kg/day, given as a continuous infusion over 24 hours for 7 consecutive days. The medication must be diluted in 0.9% Sodium Chloride Injection before use. It is available in single-use vials containing 10 mg (1 mg/mL) of cladribine.
There is also an oral tablet form (mainly used for multiple sclerosis), but for blood cancers, the IV form is standard.
How it works
Cladribine is a synthetic chemotherapy drug that targets certain white blood cells, especially lymphocytes and monocytes. It works by mimicking a natural building block of DNA, which allows it to enter cells and disrupt their ability to make and repair DNA. Once inside the cell, cladribine is converted into its active form, which accumulates in cells with high levels of a specific enzyme (deoxycytidine kinase). These cells, which include many cancerous lymphocytes, are unable to repair DNA damage, leading to cell death.
Cladribine is unique because it can kill both actively dividing and resting (non-dividing) lymphocytes. This makes it particularly effective for certain blood cancers, as it helps reduce the number of abnormal white blood cells and allows normal blood cell counts to recover.
Common side effects
- Fatigue (31%)
- Fever (33%)
- Nausea (22%)
- Headache (14%)
- Rash (16%)
- Vomiting (9%)
- Diarrhea (7%)
- Cough (7%)
- Dizziness (6%)
- Myalgia (muscle pain, 6%)
- Pain (6%)
- Decreased appetite (8%)
- Insomnia (3%)
- Chills (2%)
- Injection/infusion site reactions (11%)
Blood-related side effects are common, including:
- Neutropenia (low white blood cells)
- Anemia (low red blood cells)
- Thrombocytopenia (low platelets)
Serious infections can occur, especially in the first month after treatment.
Who Should take it
Cladribine is approved for the treatment of active Hairy Cell Leukemia, a rare type of blood cancer. It is used when patients have significant symptoms or low blood counts (anemia, neutropenia, or thrombocytopenia) due to the disease.
While cladribine is not specifically approved for Chronic Lymphocytic Leukemia (CLL), it is sometimes used off-label for other blood cancers where similar types of abnormal lymphocytes are present. Your doctor will determine if cladribine is appropriate for your specific condition based on your disease characteristics and overall health.
Who should not take it
Cladribine should not be used in patients who are allergic to cladribine or any of its components. It is also not recommended for people with severe kidney or liver problems, or those with active infections, as the drug can further suppress the immune system and blood counts.
Pregnant women should not take cladribine, as it can cause harm to the unborn baby. Women of childbearing age should use effective contraception during treatment. Cladribine is also not recommended for use in children, as its safety and effectiveness have not been established in pediatric patients.
Commonly used with
Cladribine is often used as a single agent for Hairy Cell Leukemia. In some cases, it may be used with supportive medications such as antibiotics (to prevent or treat infections), antiemetics (for nausea), and transfusions (for low blood counts).
It is important to avoid using cladribine with other drugs that suppress the immune system or bone marrow unless specifically directed by your doctor, as this can increase the risk of side effects.
Commonly tested with
In clinical studies, cladribine has been tested as a single agent for Hairy Cell Leukemia. It has also been studied in combination with other chemotherapy drugs (such as cyclophosphamide) and as part of conditioning regimens for bone marrow transplantation, but these uses are less common and associated with higher risks.
Routine blood tests are performed before, during, and after treatment to monitor blood counts and organ function. Your doctor may also monitor for infections and other complications during therapy.