Drug Detail:Chlorambucil (Chlorambucil)
Drug Class: Alkylating agents
Usual Adult Dose for Hodgkin's Disease
NOTE: The literature and/or local protocol should be consulted for full details of the treatment schedules used.
For initiation of therapy or for short courses of treatment:
0.1 to 0.2 mg/kg orally daily for 3 to 6 weeks as required; this usually amounts to 4 to 10 mg per day for the average patient; the entire daily dose may be given at one time
Comments:
- The dosage should be adjusted according to the response of the patient and should be reduced as soon as there is an abrupt fall in the white blood cell count.
- Patients with Hodgkin's disease usually require 0.2 mg/kg daily.
- Patients with other lymphomas or chronic lymphocytic leukemia usually require 0.1 mg/kg daily. When lymphocytic infiltration of the bone marrow is present, or when the bone marrow is hypoplastic, the daily dose should not exceed 0.1 mg/kg (about 6 mg for the average patient).
Alternate schedules for the treatment of chronic lymphocytic leukemia employing intermittent, biweekly, or once-monthly pulse doses have been reported. Intermittent schedules begin with an initial single dose of 0.4 mg/kg. Doses are generally increased by 0.1 mg/kg until control of lymphocytosis or toxicity is observed. Subsequent doses are modified to produce mild hematologic toxicity. It is felt that the response rate of chronic lymphocytic leukemia to the biweekly or once-monthly schedule of administration is similar or better to that previously reported with daily administration and that hematologic toxicity was less than or equal to that encountered in studies using daily doses.
Comments:
- Radiation and cytotoxic drugs render the bone marrow more vulnerable to damage, and this drug should be used with particular caution within 4 weeks of a full course of radiation therapy or chemotherapy; however, small doses of palliative radiation over isolated foci remote from the bone marrow will not usually depress the neutrophil and platelet count. In these cases, this drug can be given in the customary dosage.
- Short courses of therapy are safer than continuous maintenance therapy, although both methods have been effective. Continuous therapy may give the appearance of "maintenance" in patients who are actually in remission and have no immediate need for further therapy. If maintenance dosage is used, it should not exceed 0.1 mg/kg daily and may be as low as 0.03 mg/kg daily.
- Typical maintenance dose is 2 mg to 4 mg daily, or less, depending on the status of the blood counts. It may, therefore, be desirable to withdraw the drug after maximal control has been achieved, since intermittent therapy reinstituted at time of relapse may be as effective as continuous treatment.
Uses: For the treatment of chronic lymphatic (lymphocytic) leukemia, malignant lymphomas including lymphosarcoma, giant follicular lymphoma, and Hodgkin's disease; this drug is not curative in any of these disorders but may produce clinically useful palliation.
Usual Adult Dose for Chronic Lymphocytic Leukemia
NOTE: The literature and/or local protocol should be consulted for full details of the treatment schedules used.
For initiation of therapy or for short courses of treatment:
0.1 to 0.2 mg/kg orally daily for 3 to 6 weeks as required; this usually amounts to 4 to 10 mg per day for the average patient; the entire daily dose may be given at one time
Comments:
- The dosage should be adjusted according to the response of the patient and should be reduced as soon as there is an abrupt fall in the white blood cell count.
- Patients with Hodgkin's disease usually require 0.2 mg/kg daily.
- Patients with other lymphomas or chronic lymphocytic leukemia usually require 0.1 mg/kg daily. When lymphocytic infiltration of the bone marrow is present, or when the bone marrow is hypoplastic, the daily dose should not exceed 0.1 mg/kg (about 6 mg for the average patient).
Alternate schedules for the treatment of chronic lymphocytic leukemia employing intermittent, biweekly, or once-monthly pulse doses have been reported. Intermittent schedules begin with an initial single dose of 0.4 mg/kg. Doses are generally increased by 0.1 mg/kg until control of lymphocytosis or toxicity is observed. Subsequent doses are modified to produce mild hematologic toxicity. It is felt that the response rate of chronic lymphocytic leukemia to the biweekly or once-monthly schedule of administration is similar or better to that previously reported with daily administration and that hematologic toxicity was less than or equal to that encountered in studies using daily doses.
Comments:
- Radiation and cytotoxic drugs render the bone marrow more vulnerable to damage, and this drug should be used with particular caution within 4 weeks of a full course of radiation therapy or chemotherapy; however, small doses of palliative radiation over isolated foci remote from the bone marrow will not usually depress the neutrophil and platelet count. In these cases, this drug can be given in the customary dosage.
- Short courses of therapy are safer than continuous maintenance therapy, although both methods have been effective. Continuous therapy may give the appearance of "maintenance" in patients who are actually in remission and have no immediate need for further therapy. If maintenance dosage is used, it should not exceed 0.1 mg/kg daily and may be as low as 0.03 mg/kg daily.
- Typical maintenance dose is 2 mg to 4 mg daily, or less, depending on the status of the blood counts. It may, therefore, be desirable to withdraw the drug after maximal control has been achieved, since intermittent therapy reinstituted at time of relapse may be as effective as continuous treatment.
Uses: For the treatment of chronic lymphatic (lymphocytic) leukemia, malignant lymphomas including lymphosarcoma, giant follicular lymphoma, and Hodgkin's disease; this drug is not curative in any of these disorders but may produce clinically useful palliation.
Usual Adult Dose for Lymphoma
NOTE: The literature and/or local protocol should be consulted for full details of the treatment schedules used.
For initiation of therapy or for short courses of treatment:
0.1 to 0.2 mg/kg orally daily for 3 to 6 weeks as required; this usually amounts to 4 to 10 mg per day for the average patient; the entire daily dose may be given at one time
Comments:
- The dosage should be adjusted according to the response of the patient and should be reduced as soon as there is an abrupt fall in the white blood cell count.
- Patients with Hodgkin's disease usually require 0.2 mg/kg daily.
- Patients with other lymphomas or chronic lymphocytic leukemia usually require 0.1 mg/kg daily. When lymphocytic infiltration of the bone marrow is present, or when the bone marrow is hypoplastic, the daily dose should not exceed 0.1 mg/kg (about 6 mg for the average patient).
Alternate schedules for the treatment of chronic lymphocytic leukemia employing intermittent, biweekly, or once-monthly pulse doses have been reported. Intermittent schedules begin with an initial single dose of 0.4 mg/kg. Doses are generally increased by 0.1 mg/kg until control of lymphocytosis or toxicity is observed. Subsequent doses are modified to produce mild hematologic toxicity. It is felt that the response rate of chronic lymphocytic leukemia to the biweekly or once-monthly schedule of administration is similar or better to that previously reported with daily administration and that hematologic toxicity was less than or equal to that encountered in studies using daily doses.
Comments:
- Radiation and cytotoxic drugs render the bone marrow more vulnerable to damage, and this drug should be used with particular caution within 4 weeks of a full course of radiation therapy or chemotherapy; however, small doses of palliative radiation over isolated foci remote from the bone marrow will not usually depress the neutrophil and platelet count. In these cases, this drug can be given in the customary dosage.
- Short courses of therapy are safer than continuous maintenance therapy, although both methods have been effective. Continuous therapy may give the appearance of "maintenance" in patients who are actually in remission and have no immediate need for further therapy. If maintenance dosage is used, it should not exceed 0.1 mg/kg daily and may be as low as 0.03 mg/kg daily.
- Typical maintenance dose is 2 mg to 4 mg daily, or less, depending on the status of the blood counts. It may, therefore, be desirable to withdraw the drug after maximal control has been achieved, since intermittent therapy reinstituted at time of relapse may be as effective as continuous treatment.
Uses: For the treatment of chronic lymphatic (lymphocytic) leukemia, malignant lymphomas including lymphosarcoma, giant follicular lymphoma, and Hodgkin's disease; this drug is not curative in any of these disorders but may produce clinically useful palliation.
Usual Pediatric Dose for non-Hodgkin's Lymphoma
The manufacturer does not recommend use of this drug in children; however, it has been used in children with Hodgkin's disease and non-Hodgkin's lymphoma. The dosage regimens are similar to those used in adults.
Usual Pediatric Dose for Hodgkin's Disease
The manufacturer does not recommend use of this drug in children; however, it has been used in children with Hodgkin's disease and non-Hodgkin's lymphoma. The dosage regimens are similar to those used in adults.
Renal Dose Adjustments
- No adjustment recommended.
- Patients with impaired renal function should be carefully monitored as they are prone to additional myelosuppression associated with azotemia.
Liver Dose Adjustments
- Dose reduction may be considered in patients with hepatic impairment; however, there are insufficient data in patients with hepatic impairment to provide a specific dosing recommendation.
- Patients with hepatic impairment should be closely monitored for toxicity as this drug is primarily metabolized in the liver.
Dose Adjustments
In general, dose selection for elderly patients should be cautious and start on the low end of the dosing range.
Precautions
US BOXED WARNINGS:
- This drug can severely suppress bone marrow function. It is a carcinogen and is also probably mutagenic and teratogenic in humans.
- This drug causes human infertility.
CONTRAINDICATIONS:
- Hypersensitivity to the active component or any of the ingredients
- Do not administer to patients whose disease has demonstrated a prior resistance to this drug
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- This drug is an active cytotoxic agent for use only under the direction of physicians experienced in the administration of such agents.
- This drug should be taken on an empty stomach (at least 1 hour before or 3 hours after a meal).
