Chlorambucil

  • Derivative of nitrogen mustard 
  • Pregnancy Category D
  • In Dermatology, used more rarely than cyclophosphamide

  • 0.05-0.2 mg/kg/ day; 4-10 mg/day (induction) then 2-4 mg/day (maintenance)

  • As above however drug metabolism does not produce acrolein so hemorrhagic cystitis is not an adverse effect

FDA (food & drug administration)

  • Chronic lymphocytic leukemia (CLL)
  • Hodgkin- lymphoma

Off label (as above +)

  • Cutaneous neoplasms
  • Granulomatous

Absolute

  • Hypersensitivity
  • Decreased bone marrow function
  • Pregnancy 
  • Lactation

Relative

  • Active infection
  • Renal disease
  • Seizure disorder

As above + 

  • risk of mood changes
  • Seizures
  • NO risk of hemorrhagic cystitis

  • *

As above but no indication for strict urinalysis follow-up (every 2-3 months initially then biannual) + evaluate for lymphadenopathy on follow up

Note

Off-label use in dermatology undesirable due to carcinogenic properties: should not be given to patients other than for leukemias/lymphomas