Leukeran is a chemotherapy drug used mainly for chronic lymphocytic leukaemia and certain lymphomas. People often wonder how fast it works, what the right dose is, and which side‑effects to watch for. This guide answers those questions, gives clear dosing tables, and points out red flags you shouldn’t ignore.
- Leukeran (chlorambucil) is an alkylating agent that interferes with cancer‑cell DNA.
- Typical adult dose ranges from 0.1mg/kg to 0.2mg/kg per day, taken orally.
- Common side‑effects include nausea, low blood counts, and mild liver changes.
- Always check for drug interactions - especially with Azoles, NSAIDs, and live vaccines.
- Regular blood tests are essential to catch problems early.
What is Leukeran and How It Works?
Leukeran, whose generic name is chlorambucil, belongs to the alkylating‑agent family. It attaches an alkyl group to DNA strands, causing breaks that prevent cancer cells from multiplying. Unlike newer targeted therapies, it doesn’t aim at a specific mutation; instead it hits rapidly dividing cells across the board.
Approved by the FDA in the 1950s, Leukeran remains a first‑line option for chronic lymphocytic leukaemia (CLL) and for some low‑grade non‑Hodgkin lymphomas. Its long‑standing use means clinicians have a solid safety record, but its non‑selective nature also brings a broader side‑effect profile.
Key points to remember about the mechanism:
- It works best when cancer cells are actively dividing.
- Because it affects all fast‑growing cells, bone‑marrow suppression is a common issue.
- Oral tablets make it convenient for home administration, reducing hospital visits.
Dosage, Administration, and Safety Tips
Getting the dose right is the single most important factor for both effectiveness and tolerability. Below is a concise table that summarizes the dosing recommendations most clinicians follow in 2025. Adjustments are made based on kidney function, age, and blood‑test results.
| Indication | Typical adult dose | Frequency | Renal adjustment |
|---|---|---|---|
| Chronic lymphocytic leukaemia (CLL) | 0.1mg/kg (max 8mg) | Once daily for 7‑14days, then a 7‑day break | If CrCl<30mL/min, reduce to 0.05mg/kg |
| Low‑grade non‑Hodgkin lymphoma | 0.2mg/kg (max 15mg) | Once daily for 7‑10days, repeat every 28days | If CrCl<30mL/min, reduce to 0.1mg/kg |
| Maintenance after remission | 0.05mg/kg | Twice weekly (Monday & Thursday) | No adjustment needed unless severe renal impairment |
Guidelines for taking the tablets:
- Swallow whole with a full glass of water; avoid crushing.
- Take on an empty stomach (at least 30minutes before food) to improve absorption.
- If you miss a dose, take it as soon as you remember unless it’s close to the next scheduled dose - then skip the missed one.
- Store tablets at room temperature, away from moisture and direct sunlight.
Safety checkpoints you should run every two weeks during the first two months, then monthly once stable:
- Complete blood count (CBC) - watch for neutropenia (<1.5×10⁹/L) or thrombocytopenia (<100×10⁹/L).
- Liver function tests - ALT/AST rising above 2‑3×ULN may need dose reduction.
- Kidney function - creatinine clearance guides dose adjustments.
- Pregnancy test for women of child‑bearing potential before starting, then monthly.
If any lab result crosses the thresholds, talk to your oncologist right away. Most clinicians will pause the drug for one week, then restart at a lower dose.
Side Effects, Drug Interactions, and Monitoring
Because Leukeran targets dividing cells indiscriminately, side‑effects can be broad. Below is a quick‑reference list of the most frequent issues and what to do about them.
| Side‑effect | Incidence | Management |
|---|---|---|
| Nausea / Vomiting | 30‑40% | Take anti‑emetics (ondansetron) 30min before dose; eat bland foods. |
| Myelosuppression | 25‑35% | Regular CBC; dose hold if neutrophils <1.0×10⁹/L. |
| Hair thinning | 15‑20% | Usually reversible; use gentle shampoos. |
| Skin rash | 10‑12% | Topical steroids; avoid sun exposure. |
| Elevated liver enzymes | 5‑8% | Monitor LFTs; reduce dose if >3×ULN. |
Key drug interactions to keep an eye on:
- Azole antifungals (ketoconazole, itraconazole) - increase Chlorambucil plasma levels; consider dose reduction.
- NSAIDs - raise risk of gastrointestinal bleeding; use acetaminophen if pain control is needed.
- Live vaccines - contraindicated while on therapy because of immune suppression.
- Other alkylating agents - cumulative bone‑marrow toxicity; avoid concurrent use.
Practical tips to minimise problems:
- Keep a medication diary - note date, dose, and any symptoms.
- Stay hydrated; good kidney function helps clear metabolites.
- Limit alcohol while on treatment - it can worsen liver toxicity.
- Report fever >38°C immediately; it may signal infection due to neutropenia.
When side‑effects become severe, your doctor might switch you to a newer agent such as ibrutinib or venetoclax, especially if you have high‑risk genetic markers.
Mini‑FAQ
- Can I take Leukeran with food? It’s best on an empty stomach. Food can lower absorption and make nausea worse.
- How long does treatment usually last? For CLL, many patients stay on low‑dose maintenance for years, while a short course (8‑12weeks) is common for low‑grade lymphoma.
- Is Leukeran safe during pregnancy? No. It’s classified as Pregnancy Category D - it can harm the fetus. Contraception is mandatory.
- Will I need to stop the drug before surgery? Usually stop 7‑10days prior to allow blood counts to recover.
- Can I travel while on Leukeran? Yes, but keep your medication in original packaging, bring a copy of your prescription, and schedule blood tests before and after long trips.
Next Steps and Troubleshooting
If you’re about to start Leukeran, schedule a baseline CBC, LFTs, and renal panel. Keep the results handy for your oncology team. Set reminders for the first two weeks of lab work - that’s when most changes surface.
Encounter a new rash or persistent nausea? Call your clinic within 24hours. Many side‑effects are manageable with simple medications, but waiting can lead to unnecessary dose reductions.
For patients whose blood counts stay low despite dose adjustments, discuss alternative therapies with your doctor. In 2025, several oral agents have shown better tolerability for high‑risk cases.
Finally, stay connected with a support group - the emotional load of chemotherapy is real, and sharing experiences often reveals practical tricks that doctors forget to mention.
