Chlorambucil Risk Summary

Risk Factor: DM
Class: Antineoplastics

Fetal Risk Summary

The use of the alkylating agent, chlorambucil, during pregnancy has resulted in both normal and deformed infants (1,2,3,4 and 5). Two reports observed unilateral agenesis of the left kidney and ureter in male fetuses following 1st trimester exposure to chlorambucil (3,4). Similar defects have been found in animals exposed to the drug (6). In a third case, a pregnant patient was treated with chlorambucil at the 10th week of gestation (5). A full-term infant was delivered but died 3 days later of multiple cardiovascular anomalies.

Chlorambucil is mutagenic as well as carcinogenic (7,8,9,10 and 11). These effects have not been reported in newborns following in utero exposure. Data from one review indicated that 40% of the infants exposed to anticancer drugs were of low birth weight (12). Long-term studies of growth and mental development in offspring exposed to chlorambucil during the 2nd trimester, the period of neuroblast multiplication, have not been conducted (13).

Amenorrhea and reversible azoospermia with high doses have been reported (14,15,16,17 and 18). Long-term follow-up of menstrual and reproductive function in women treated with various antineoplastic agents was reported in 1988 (18). Only two of the 40 women studied, however, may have been exposed to chlorambucil (see Cyclophosphamide).

Occupational exposure of the mother to antineoplastic agents during pregnancy may present a risk to the fetus. A position statement from the National Study Commission on Cytotoxic Exposure and a research article involving some antineoplastic agents are presented in the monograph for cyclophosphamide (see Cyclophosphamide).

Breast Feeding Summary

No reports describing the use of chlorambucil during lactation have been located. Because of the potential for severe adverse effects in a nursing infant, women receiving this alkylating agent should not breast feed.

References

1. Sokal JE, Lessmann EM. Effects of cancer chemotherapeutic agents on the human fetus. JAMA 1960;172:176571.
2. Jacobs C, Donaldson SS, Rosenberg SA, Kaplan HS. Management of the pregnant patient with Hodgkin's disease. Ann Intern Med 1981;95:66975.
3. Shotton D, Monie IW. Possible teratogenic effect of chlorambucil on a human fetus. JAMA 1963;186:745.
4. Steege JF, Caldwell DS. Renal agenesis after first trimester exposure to chlorambucil. South Med J 1980;73:14145.
5. Thompson J, Conklin KA. Anesthetic management of a pregnant patient with scleroderma. Anesthesiology 1983;59:6971.
6. Monie IW. Chlorambucil-induced abnormalities of urogenital system of rat fetuses. Anat Rec 1961;139:145.
7. Lawler SD, Lele KP. Chromosomal damage induced by chlorambucil and chronic lymphocytic leukemia. Scand J Haematol 1972;9:60312.
8. Westin J. Chromosome abnormalities after chlorambucil therapy of polycythemia vera. Scand J Haematol 1976;17:197204.
9. Catovsky D, Galton DAG. Myelomonocytic leukaemia supervening on chronic lymphocytic leukaemia. Lancet 1971;1:4789.
10. Rosner R. Acute leukemia as a delayed consequence of cancer chemotherapy. Cancer 1976;37:10336.
11. Reimer RR, Hover R, Fraumeni JF, Young RC. Acute leukemia after alkylating-agent therapy of ovarian cancer. N Engl J Med 1977;297:17781.
12. Nicholson HO. Cytotoxic drugs in pregnancy: review of reported cases. J Obstet Gynaecol Br Commonw 1968;75:30712.
13. Dobbing J. Pregnancy and leukaemia. Lancet 1977;1:1155.
14. Freckman HA, Fry HL, Mendex FL, Maurer ER. Chlorambucil-prednisolone therapy for disseminated breast carcinoma. JAMA 1964;189:1114.
15. Richter P, Calamera JC, Morganfeld MC, Kierszenbaum AL, Lavieri JC, Mancinni RE. Effect of chlorambucil on spermatogenesis in the human malignant lymphoma. Cancer 1970;25:102630.
16. Morgenfeld MC, Goldberg V, Parisier H, Bugnard SC, Bur GE. Ovarian lesions due to cytostatic agents during the treatment of Hodgkin's disease. Surg Gynecol Obstet 1972;134:8268.
17. Schilsky RL, Lewis BJ, Sherins RJ, Young RC. Gonadal dysfunction in patients receiving chemotherapy for cancer. Ann Intern Med 1980;93:10914.
18. Gershenson DM. Menstrual and reproductive function after treatment with combination chemotherapy for malignant ovarian germ cell tumors. J Clin Oncol 1988;6:2705.

Questions and Answers

What is the efficacy of using orally administered Chlorambucil and Prednisolone to treat CLL?, TLC: 159,000.
Lymphocytes: 86%.
PMNs: 2%.
Prolymphocytes: 12%.
Platelets: 83,000.
RBCs: 3.26mill/cmm.
Hb: 10.2.
Splenomegaly and lymphadenopathy present.

About 15-20% of patients will experience severe (grade 3 or 4) low platelet or WBC counts. < 10% have infectious complications. Some nausea is possible but not very common. Rare problems include lung and liver toxicity, fever, seizures. Main concern is blood count supression. My experience is most patients complain about very little from the chlorambucil.
Prednisone on the other hand can be different. Some patients either love it because it gives them good energy and appetite or hate it as it makes them moody/irritable, edgy, and bloated. It can wreak havoc with diabetes (and elevate your sugar even if you don't have a diabetes diagnosis) and also your bones over the long haul.

God bless, best wishes

My doctor wants me to go on chlorambucil to treat my uveitis for ten months?, its usually used for lumkemia has anyone ever been on it, if so what did you experience?

You're correct in that chlorambucil (Leukeran) is used to treat chronic lymphocytic leukemia and also lymphomas and Hodgkin's disease. It's also usde to treat macroglobulinemia, nephrotic syndrome, Behcet's syndrome and....tah tah...intractable idiopathic uveitis.

Speak to your doctor about possible adverse effects including those that are common, less common and life-threatening.

Anyone ever had a cat who survived FIP?, My cat has been definitively diagnosed with FIP, through biopsy. He's on chlorambucil, prednisone, antibiotics, antibiotic eye drops (his right eye has been affected - it is inflamed and the retina has partially detached), and interferon.

Does anyone have a cat that survived FIP after being definitively diagnosed? The sources I read are conflicting on survival rates, with most stating 100% fatality rates.

I am doing everything in my power to help my cat. I just would like to have a little more hope. If your cat survived, what did you do to help kick the disease?

Unfortunately, the survival rate is not all that good. We just recently got a new kitten, and since one of our other cats died from FIP, I asked if they had any new treatments/vaccines for that yet. My vet said unfortunately, there still is no cure for this horrible disease. You can keep them comfortable for a while but, in the end, they usually don't survive. I hope your cat is one that will.

Blessings to you and your beloved cat. I know what you're going through and it's not easy!

My 1year old dashchund has been diagnosed with IMHA she has had 3 blood transfusions what are her chances?, she had a reactions to the last transfusion, it has been 4 months since her diagnose. She has been on procrit, baytril,pretizone,chlorambucil to name a few. I have her on a raw meat diet that I cook which I purchase at a local pet store. Is there any test that should be being done?

Keep positive hope. Make sure you keep her fluids up as well and there is always hope.

Continue reading here: Clavulanate Potassium Risk Summary

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