Cladribine (2-CdA, Leustat, Litak)

Cladribine is a chemotherapy drug used mainly to treat hairy cell leukaemia and occasionally other types of leukaemia and lymphoma.

Cladribine is one of a group of chemotherapy drugs known as anti metabolites. These stop cells making and repairing DNA. Cancer cells need to make and repair DNA so that they can grow and multiply.

Cladribine is a clear liquid that you have through a fine tube (a cannula) into a vein (intravenously). Or you may have the infusion through a central line, a portacath, or a PICC line. These are long, flexible tubes that give the chemotherapy into a large vein in the chest. These lines stay in throughout your whole course of treatment. You may have the drug continuously over 7 days. Or you may have it as a 2 hour drip.

Cladribine is sometimes given as an injection just under the skin.

You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for cladribine depends on which type of cancer you have. There is more about planning chemotherapy in the main chemotherapy section.

The side effects associated with cladribine are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link, please see our cancer drugs side effects section or use the search box at the top of the page.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or may feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• High temperatures (fever) in about 7 out of 10 patients – you may also feel weak and have aching muscles and joints but this will lessen as the treatment continues
• Cladribine may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant

Between 1 and 10 in every 100 people have one or more of the following side effects.

• Feeling or being sick –  this is usually mild, affects fewer than 3 out of 10 people, and is usually easily controlled with anti sickness medicines
• Skin rash
• Headaches
• Loss of appetite

Fewer than 1 in 100 people have these.

• Dizziness
• Trouble sleeping (insomnia)
• Abdominal cramps and constipation – your doctor or nurse may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• A skin reaction at the drip site, with swelling, pain and redness
• Diarrhoea – drink plenty of fluid and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
• Fast heart beat (tachycardia)
• Swollen ankles
• A cough
• Women may stop having periods (amenorrhoea) but this may only be temporary
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if this is important to you

You may have 1 or 2 or more of the side effects listed above. The side effects may be mild for some people and more severe for others. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.