Chlorambucil (LEUKERAN)

Chronic lymphocytic leukemia

Hodgkin lymphoma

Non-Hodgkins lymphoma

Waldenstrom’s Macroglobulinemia

Chronic lymphocytic leukemia, Hodgkin lymphoma, Non-Hodgkins lymphoma, Waldenstrom’s Macroglobulinemia

• Oral: Dose/frequency varies depending on diagnosis and local practice, including weight-based dosing, dosing based on body surface area, daily dosing, and biweekly dosing.
• Please refer to selected regimen.
• Given in combination with obinutuzumab or rituximab

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Available as 2mg film coated tablet. Contains lactose. Tablets should NOT be crushed or broken. Store in refrigerator.

Alkylating agent

Administer on an empty stomach with water

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Common: Allergic cutaneous reactions, Hemolytic anemia, Leukopenia, Neutropenia, Lymphopenia, Thrombocytopenia.‍

Less Common: Pulmonary Fibrosis, Sterility/infertility, Hyperuricemia.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, HBsAg, HBcoreAb.

During treatment: CBC & differential, platelets.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Seizures have been reported with Chlorambucil. Patients with a history of seizures or head trauma, or on other epileptogenic medications may be at increased risk of seizures with chlorambucil.
• Hematologic adverse effects - The most common side effect is bone marrow suppression, anemia, leukopenia, neutropenia, thrombocytopenia, or pancytopenia. blood counts should be closely monitored in patients undergoing treatment.
• Rare instances of skin rash progressing to erythema multiforme, toxic epidermal necrolysis, or Stevens-Johnson syndrome have been reported. Chlorambucil should be discontinued promptly in patients who develop skin reactions.

BC Cancer. BC Cancer Drug Manual. Chlorambucil.  Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Chlorambucil_monograph_1Sept2013_formatted1.pdf . Updated September 1, 2013. Accessed January 22, 2024.

Lexicomp. Chlorambucil Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/6581?cesid=13TTExrnNT1&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3DChlorambucil%26t%3Dname%26acs%3Dfalse%26acq%3DChlorambucil. Updated December 5, 2023. Accessed January 31, 2024.

Cancer Care Ontario. Chlorambucil Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/43876. Updated June 2019. Accessed January 22, 2024.GlaxoSmithKline Inc. LEUKERAN® Product Monograph. Mississauga, Ontario. Updated August 23, 2017.