Leukeran (Chlorambucil)

Leukeran (chlorambucil) is used in oncology to target malignant lymphoid and selected solid tumours.

• Chronic lymphocytic leukemia (CLL): helps achieve disease control and prolong remission.
• Hodgkin's lymphoma: contributes to achieving remission when used in combination regimens.
• Non‑Hodgkin's lymphoma: aids in tumour reduction and disease stabilization.
• Ovarian cancer: incorporated into chemotherapy protocols to improve response rates.

• Chlorambucil alkylates DNA by forming covalent bonds with guanine bases, creating cross‑links between DNA strands. This interferes with DNA replication and transcription, ultimately triggering apoptosis of rapidly dividing cancer cells. The drug’s nitrogen‑mustard structure enables it to penetrate cells and bind DNA, disrupting the cell cycle and leading to cell death.

Leukeran may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea and vomiting: gastrointestinal upset that may require anti‑emetic support.
• Bone marrow suppression: reduced blood cell counts leading to fatigue or infection risk.
• Alopecia: temporary hair loss during treatment.
• Diarrhea: loose stools that may need hydration and monitoring.

Serious or Rare Side Effects

• Severe neutropenia or aplastic anemia: profound loss of white blood cells requiring urgent medical care.
• Secondary malignancies: potential development of new cancers after prolonged exposure.
• Severe hepatic toxicity: liver enzyme elevations or hepatitis that may necessitate discontinuation.

Before initiating Leukeran, several safety considerations should be observed.

• Monitor blood counts: perform regular CBCs to detect marrow suppression early.
• Assess liver function: evaluate hepatic enzymes prior to and during therapy.
• Adjust dose in renal impairment: consider reduced dosing for patients with compromised kidney function.
• Avoid use in pregnancy: chlorambucil is classified as Category D and may cause fetal harm.
• Use effective contraception: both male and female patients should employ reliable birth control throughout treatment and for a defined period after.
• Store at room temperature: keep tablets in the original packaging, protect from moisture and direct sunlight.

Chlorambucil can interact with several medicines, affecting efficacy or safety.

Major Interactions (Avoid)

• Warfarin: increased anticoagulant effect may lead to bleeding.
• Live vaccines: risk of uncontrolled infection due to immunosuppression.
• Other myelotoxic agents (e.g., cyclophosphamide): additive bone‑marrow toxicity.

Moderate Interactions (Monitor Closely)

• Allopurinol: may enhance chlorambucil toxicity; monitor blood counts.
• NSAIDs: can increase risk of renal impairment when combined.
• Antacids containing aluminum or magnesium: may affect drug absorption; separate dosing times.