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Systemic Anti-Cancer Therapy Regimen Library

Home > LEU HCL - cladribine

LEU HCL - cladribine

Treatment Overview

Usually a single course, if a second course is necessary it should be delayed until the haematological toxicities of chemotherapy have resolved.


This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.

Cycle 1 - 28 days

Cycle length:
28

filgrastim: Give 5 microgram/kg (rounded to 300 or 480 micrograms) subcutaneously ONCE daily from day 6 until neutrophil recovery past the nadir.

Cycle details

Cycle 1 - 28 days

Medication Dose Route Days Max Duration
cladribine * 0.14 mg/kg Once daily intravenous 1 to 5 120 minutes
filgrastim 5 microgram/kg Once daily subcutaneous injection 6

filgrastim: Give 5 microgram/kg (rounded to 300 or 480 micrograms) subcutaneously ONCE daily from day 6 until neutrophil recovery past the nadir.

Full details

Cycle 1 - 28 days

Day: 1

Medication Dose Route Max duration Details
cladribine * 0.14 mg/kg Once daily intravenous 120 minutes

Day: 2

Medication Dose Route Max duration Details
cladribine * 0.14 mg/kg Once daily intravenous 120 minutes

Day: 3

Medication Dose Route Max duration Details
cladribine * 0.14 mg/kg Once daily intravenous 120 minutes

Day: 4

Medication Dose Route Max duration Details
cladribine * 0.14 mg/kg Once daily intravenous 120 minutes

Day: 5

Medication Dose Route Max duration Details
cladribine * 0.14 mg/kg Once daily intravenous 120 minutes

Day: 6

Medication Dose Route Max duration Details
filgrastim 5 microgram/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily from Day 6 until neutrophil recovery past the nadir.

Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Routine antifungal prophylaxis may be considered
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Emetogenicity: Minimal
Growth factor support: Recommended for primary prophylaxis
Irradiated blood components: Irradiation of blood components is recommended
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis may be considered

Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.

References

Goodman, G. R., C. Burian, J. A. Koziol, et al. 2003. "Extended follow-up of patients with hairy cell leukemia after treatment with cladribine." J Clin Oncol 21(5):891-896. , PMID: 12610190

Hoffman, M. A., D. Janson, E. Rose, et al. 1997. "Treatment of hairy-cell leukemia with cladribine: response, toxicity, and long-term follow-up." J.Clin Oncol. 15(3):1138-1142. , PMID: 9060556

Piro, L. D., C. J. Carrera, D. A. Carson, et al. 1990. "Lasting remissions in hairy-cell leukemia induced by a single infusion of 2-chlorodeoxyadenosine." N Engl J Med 322(16):1117-1121. , PMID: 1969613

Saven, A., C. Burian, J. A. Koziol, et al. 1998. "Long-term follow-up of patients with hairy cell leukemia after cladribine treatment." Blood. 92(6):1918-1926. , PMID: 9731048

Zenhausern, R., S. F. Schmitz, M. Solenthaler, et al. 2009. "Randomized trial of daily versus weekly administration of 2-chlorodeoxyadenosine in patients with hairy cell leukemia: a multicenter phase III trial (SAKK 32/98)." Leuk Lymphoma 50(9):1501-1511. , PMID: 19672771

Zinzani, P. L., M. Tani, E. Marchi, V. Stefoni, L. Alinari, G. Musuraca, A. Gabriele, S. Pileri and M. Baccarani. 2004. "Long-term follow-up of front-line treatment of hairy cell leukemia with 2-chlorodeoxyadenosine." Haematologica 89(3):309-313. , PMID: 15020269

Lauria, F., M. Bocchia, G. Marotta, D. Raspadori, P. L. Zinzani and D. Rondelli. 1999. "Weekly administration of 2-chlorodeoxyadenosine in patients with hairy-cell leukemia is effective and reduces infectious complications." Haematologica. 84(1):22-25. , PMID: 10091389

Juliusson, G., D. Heldal, E. Hippe, et al. 1995. "Subcutaneous injections of 2-chlorodeoxyadenosine for symptomatic hairy cell leukemia." J.Clin Oncol. 13(4):989-995. , PMID: 7707128

Grever, M. R., O. Abdel-Wahab, L. A. Andritsos, et al. 2017. "Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia." Blood 129(5):553-560. , PMID: 27903528

Liliemark, J., F. Albertioni, M. Hassan, et al. 1992. "On the bioavailability of oral and subcutaneous 2-chloro-2'-deoxyadenosine in humans: alternative routes of administration." J.Clin Oncol. 10(10):1514-1518. , PMID: 1357107

Ravandi, F., S. O'Brien, J. Jorgensen, et al. 2011. "Phase 2 study of cladribine followed by rituximab in patients with hairy cell leukemia." Blood 118(14):3818-3823. , PMID: 21821712

Else, M., C. E. Dearden, E. Matutes, et al. 2009. "Long-term follow-up of 233 patients with hairy cell leukaemia, treated initially with pentostatin or cladribine, at a median of 16 years from diagnosis." Br J Haematol 145(6):733-740. , PMID: 19344416

New Zealand Blood Service Transfusion Medicine Handbook Third Edition, 2016 https://www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/111G122.pdf (accessed 3/2/2022).

Clinect NZ Pty Limited New Zealand datasheet 23 March 2022 https://www.medsafe.govt.nz/profs/Datasheet/l/Leustatininf.pdf (Accessed 13 April 2022).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.