Hj. Guchelaar et al., CLINICAL AND TOXICOLOGICAL ASPECTS OF THE ANTINEOPLASTIC DRUG CLADRIBINE - A REVIEW, Annals of hematology, 69(5), 1994, pp. 223-230
Cladribine (2-chlorodeoxyadenosine, 2-CdA) is a new antineoplastic dru
g which exerts its anti-lymphoproliferative activity by its resistance
to the enzyme adenosine deaminase. Cladribine is mostly administered
as a 7-day continuous infusion and in a dose of 0.1 mg/kg/day. However
, preliminary data show that the subcutaneous and oral routes of admin
istration might be feasible. The drug is well tolerated, and myelosupp
ression was found to be the dose-limiting toxicity. Nonhematological t
oxicity, such as alopecia, nausea, vomiting, stomatitis, diarrhea, and
organ toxicity is mild or absent. Cladribine has shown efficacy in ph
ase-II studies in hairy cell leukemia [response rate (RR) = 75-100% an
d complete response rate (CR) = 46-92%], chronic lymphocytic leukemia
(RR = 37-67% and CR = 4-39%), and lymphocytic lymphoma (RR = 43-52% an
d CR = 14-20%). Furthermore, there is preliminary evidence that cladri
bine might be effective in the treatment of cutaneous T cell lymphoma
(RR = 47% and CR = 20%), acute myeloid leukemia in children (RR = 59%
and CR = 47%), acute lymphoid leukemia in children (RR = 14% and CR =
14%) and Waldenstrom macroglobulinemia (RR = 58% and CR = 3.5%). In mu
ltiple myeloma cladribine was not effective. Comparative randomized st
udies with established first-line and second-line therapeutic regimens
are warranted and will define the ultimate place of cladribine in the
therapy of malignant hematological disorders.