allopurinol and Leukemia--Hairy-Cell

Cladribine is a purine analog used in first-line treatment of hairy cell leukemia and in relapsed/refractory chronic lymphocytic anemia. Although cladribine is typically associated with mild, self-limited skin reactions, there is increasing evidence that cladribine may increase the risk of severe cutaneous adverse reactions (SCAR) when combined with drugs classically associated with SCAR (e.g. allopurinol) beyond what would be expected for either drug alone, possibly due to cladribine-induced lymphopenia. We analyzed all SCAR cases reported for cladribine in Janssen's Global Safety Database and found that 26/35 (74.3%) reported concomitant drugs known to be associated with SCAR, most commonly sulfamethoxazole/trimethoprim (SMX/TMP) and allopurinol. In addition, a review of the WHO VigiBase showed that several drugs, including penicillins, SMX/TMP, and allopurinol had a statistically significant contribution to cladribine-associated SCAR. These results lend further support that cladribine may increase the propensity of these drugs to cause SCARs.

Topics: Allopurinol; Cladribine; Humans; Leukemia, Hairy Cell; Skin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Allopurinol; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cladribine; Drug Eruptions; Drug Monitoring; Exanthema; Humans; Leukemia, Hairy Cell; Male; Pigmentation Disorders; Purpura; Severity of Illness Index; Treatment Outcome

The purine nucleoside analogue 2-chlorodeoxyadenosine (2-CdA) is currently considered by many as first-line therapy for hairy cell leukaemia. Cutaneous reactions have occasionally been reported with this drug, particularly if used with allopurinol. We report a high frequency of skin reactions in 15 consecutive patients with hairy cell leukaemia treated with 17 courses of 2-CdA. These reactions occurred only in those receiving allopurinol and, in two patients, were severe enough to warrant steroid therapy. The routine concomitant use of allopurinol is therefore not recommended in this setting.

Topics: Adult; Aged; Allopurinol; Antineoplastic Combined Chemotherapy Protocols; Cladribine; Drug Eruptions; Female; Humans; Leukemia, Hairy Cell; Male; Middle Aged; Retrospective Studies

Of eight patients with progressive hairy cell leukemia who were treated with daily doses of an alkylating agent (chlorambucil, 4 mg) for at least 6 mo, seven have had an objective response, as measured by improved blood counts. Two patients were pancytopenic and had almost total bone marrow replacement with hairy cells at the initiation of chemotherapy; approximatley 6 mo later, their blood counts and bone marrow had improved dramatically. The five other patients had the leukemic form of the disease, and all responded to therapy. It is important to identify postsplenectomy patients with progressive disease in order to initiate low-dose single-agent chemotherapy.

Topics: Allopurinol; Blood Platelets; Bone Marrow Examination; Chlorambucil; Humans; Leukemia, Hairy Cell; Leukocyte Count; Leukocytes; Platelet Count; Splenectomy