Leukeran is a brand-name prescription drug that’s FDA-approved to treat the following forms of cancer in adults:

Leukeran contains the chemotherapy drug chlorambucil. It belongs to a class of drugs called alkylating agents. (Chemotherapy describes traditional drugs used to treat cancer. And a drug class describes a group of medications that work in the same way.)

The safety and effectiveness of Leukeran hasn’t been studied in children. For this reason, the drug isn’t recommended for use in people younger than 18 years of age.

Leukeran is available in tablets of 2 milligrams (mg) that are taken by mouth.

Effectiveness

For information on Leukeran’s effectiveness, see the section “Leukeran uses” below.

Leukeran contains the active drug chlorambucil. It’s available only as a brand-name medication. It’s not currently available in generic form.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics usually cost less than brand-name drugs.

The Leukeran dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Leukeran to treat
  • your weight
  • how often you take Leukeran
  • other medical conditions you may have
  • results from certain lab tests you’ll have while you’re taking Leukeran

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Leukeran is available as 2-mg tablets that are taken by mouth.

Dosage for chronic lymphocytic leukemia

The usual dose of Leukeran for chronic lymphocytic leukemia (CLL) is 0.1 mg of drug per kilogram of body weight (mg/kg). This dose is typically taken once daily.

Intermittent dosing vs. daily dosing for CLL

In some cases, doctors may prescribe intermittent dosing for Leukeran for CLL rather than daily dosing. With intermittent dosing, the drug is taken once every 2 weeks or once each month. And in these cases, the dose of Leukeran given may be different than the typical dose given.

For some people with CLL, intermittent Leukeran dosing works better than daily dosing. In addition, certain side effects, such as changes in blood cell levels, may be reduced with intermittent dosing.

Dosage for lymphoma

Below we describe the typical doses of Leukeran for certain types of lymphoma that Leukeran is approved to treat.

Dosage for certain types of non-Hodgkin lymphoma (NHL), such as follicular lymphoma (FL)

The usual dose of Leukeran to treat certain types of NHL, such as FL, is 0.1 mg of drug per kg of body weight (mg/kg). This dose is typically taken once each day.

Dosage for Hodgkin lymphoma (HL)

The usual dose of Leukeran to treat HL is 0.2 mg/kg. This dose is typically taken once each day.

Pediatric dosage

The safety and effectiveness of Leukeran hasn’t been studied in children. But in some cases, Leukeran is prescribed for children with certain conditions. (Keep in mind that this is an off-label use of the drug. With off-label use, a drug that’s approved for certain uses is given or being studied for a different use.)

Because the Leukeran hasn’t been approved for use in children, the drug’s manufacturer hasn’t recommended a typical dosage for children.

If you have questions about pediatric dosage for Leukeran, talk with your child’s doctor. They can recommend a dosage of Leukeran for your child’s needs.

What if I miss a dose?

If you miss a dose of Leukeran, call your doctor’s office. You doctor or their medical staff can help you determine when you should take your next dose of the drug. And they’ll recommend whether you should take a dose to make up for the missed dose.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Will I need to use this drug long term?

It depends. The number of Leukeran treatment cycles you’ll receive may depend on several factors. These include the type and severity of your cancer, as well as your medical history.

In one study of people with CLL, the people took chlorambucil (the active drug in Leukeran) every 28 days for up to 12 months. And a review of studies found that, across several clinical studies of chlorambucil for CLL treatment, people took between 6 and 12 treatment cycles of the drug.

Leukeran is usually given every day for 3 to 6 weeks. But your doctor may recommend that you take it once every 2 weeks or once each month.

If you have questions about how long you’ll need to take Leukeran, talk with your doctor.

Leukeran can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Leukeran. These lists don’t include all possible side effects.

For more information on the possible side effects of Leukeran, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Leukeran, you can do so through MedWatch.

Depending on the condition you’re using Leukeran to treat, your side effects may vary from those listed below.

Mild side effects

Mild side effects of Leukeran can include:*

  • nausea or vomiting
  • diarrhea
  • sores in your mouth
  • fever
  • muscle problems, such as muscle twitches, spasms, weakness, or loss of muscle tone

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Leukeran. To learn about other mild side effects, talk with your doctor or pharmacist, or visit Leukeran’s prescribing information.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

  • Peripheral neuropathy (nerve damage). Symptoms can include:
    • numbness or tingling in your hands or feet
  • Problems with your central nervous system (CNS), which is made up of your brain and spinal cord. Symptoms can include:
    • confusion
    • agitation, which may cause irritability and anger
  • Lung problems. Symptoms can include:
    • shortness of breath
    • chest tightness
  • Infertility (inability to get pregnant or cause pregnancy).* Symptoms can include:
    • amenorrhea (missed or absent periods) in women using the drug
    • azoospermia (absence of sperm in semen) in men using the drug
  • Fetal harm if used during pregnancy.*

Other serious side effects, which are explained in more detail below in “Side effect details,” include:

* Leukeran has a boxed warning regarding the risk of bone marrow suppression, increased risk of cancer, fetal harm, and infertility. A boxed warning is the strongest warning required by the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

Side effects in children

Leukeran isn’t approved for use in children. This is because the drug’s safety and effectiveness hasn’t been studied in people younger than 18 years of age. But sometimes, Leukeran is prescribed off-label for children. (With off-label use, a drug that’s approved for certain uses is given for a different use.)

Studies have shown that seizures are a possible side effect in children using Leukeran. The risk of seizures may be increased in children with:

  • nephrotic syndrome (signs and symptoms that result from kidney damage)
  • seizure disorders or a history of seizures
  • a history of head trauma

The risk of seizures with Leukeran is also increased when high doses of the drug are given. But it’s important to note that there’s no typical recommended dosage of Leukeran for children.

Tell your doctor if your child has any risk factors for seizures. Your doctor can recommend whether it’s safe for your child to use this drug.

Side effect details

You may wonder how often certain side effects occur with this drug.Here’s some detail on several of the side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Leukeran. But it’s not known how many people taking Leukeran have had an allergic reaction to the drug.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing
  • severe skin rashes, including erythema multiforme, toxic epidermal necrolysis (TEN), and Stevens-Johnson syndrome (SJS)

If you develop a severe rash while using Leukeran, your doctor may recommend that you stop taking the drug.

Call your doctor right away if you have a severe allergic reaction to Leukeran. But call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Seizures

Seizures have occurred in people taking Leukeran, even when the drug was given at typical doses. You may have an increased risk of seizures if you:

  • take doses of Leukeran that are higher than the usual dose
  • have a seizures disorder or a history of seizures
  • have had head injuries in the past
  • are a child with nephrotic syndrome (signs and symptoms that result from kidney damage)
  • take Leukeran with other medications that may increase the risk of seizures, such as bupropion (Wellbutrin)

If you’re concerned about having seizures during Leukeran treatment, talk with your doctor. They can discuss with you the risks and benefits of using this drug.

Blood disorders

Leukeran may decrease the ability of your bone marrow to make new blood cells. This condition, called bone marrow suppression, may lead to blood disorders such as:

The Food and Drug Administration (FDA) has placed a boxed warning on Leukeran regarding the risk of bone marrow suppression. A boxed warning is the strongest warning required by the FDA. Boxed warnings alert doctors and patients about drug effects that may be dangerous.

It’s not known for sure how many people taking Leukeran have had blood cell disorders. Depending on which blood cells are affected, these disorders may increase your risk of:

  • anemia
  • infections
  • bruising or bleeding more often than usual

During treatment with Leukeran, your doctor will check your blood cell counts often to monitor for blood disorders. Talk with your doctor about possible symptoms of blood disorders that you can watch for. If your blood cell counts become too low during treatment, your doctor may recommend that you stop using Leukeran.

If you have questions about having blood disorders during Leukeran treatment, talk with your doctor.

Liver damage

Leukeran may cause liver damage in some people. When your liver is damaged, it may not function normally. Symptoms of liver damage can include:

If you have any symptoms of liver damage while you’re taking Leukeran, talk with your doctor. They can check to see if your liver function has been affected by the drug.

And also, tell your doctor if you’ve had any liver problems in the past, or if you currently have liver problems. If this is the case, your doctor may recommend a dosage of Leukeran for you that’s lower than the typical dosage. Or they may recommend that you take a medication other than Leukeran.

Other cancers

In some people, Leukeran may increase the risk of certain types of cancer. In fact, the Food and Drug Administration (FDA) has placed a boxed warning on Leukeran regarding this risk. A boxed warning is the strongest warning required by the FDA. Boxed warnings alert doctors and patients about drug effects that may be dangerous.

For example, leukemia has been reported in people taking Leukeran who were being treated for a type of cancer other than leukemia or lymphoma. Specifically, people taking chlorambucil (the active the drug in Leukeran) have an increased risk of acute myeloid leukemia (AML).

In most cases, the people affected were also taking other medications with Leukeran. Or the people were being treated with radiation therapy in addition to Leukeran.

In addition, it’s thought that the risk of cancer increases when Leukeran is used over long periods of time or given at high dosages.

Because of the risk of cancer, Leukeran is only approved to treat chronic lymphocytic leukemia (CLL) and certain types of lymphoma. Before your doctor prescribes Leukeran for you, they’ll consider the risks and benefits of using this drug for your treatment. Your doctor can recommend if this drug is a good option for you.

The Food and Drug Administration (FDA) approves prescription drugs such as Leukeran to treat certain conditions. Leukeran may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Leukeran for chronic lymphocytic leukemia

Leukeran is a chemotherapy drug that’s FDA-approved to treat chronic lymphocytic leukemia (CLL). (Chemotherapy describes traditional drugs used to treat cancer.) Leukeran is approved for use in adults with this condition.

CLL is a type of cancer that starts in your bone marrow. Normally, your bone marrow makes all your blood cells. This includes your red blood cells, white blood cells, and platelets. But with CLL, your bone marrow starts making abnormal blood cells. Specifically, with CLL your body starts making abnormal lymphocytes, which are a type of white blood cell.

CLL is a slow-growing form of cancer. Sometimes, it can take years to notice any symptoms of CLL.

Effectiveness for chronic lymphocytic leukemia

In current guidelines, Leukeran is recommended as an option for CLL treatment. For example, Leukeran is mentioned in guidelines from both the National Comprehensive Cancer Network (NCCN) and the National Cancer Institute (NCI).

The NCCN guidelines that mention Leukeran as a treatment option for CLL are evidence-based guidelines. Evidence-based guidelines are made by clinical experts who’ve reviewed clinical trials and safety information for each treatment included in the guidelines.

However, some newer therapies for CLL may be preferred over Leukeran. These newer drugs have shown better long-term outcomes than Leukeran has. And Leukeran can increase your risk for developing certain types of cancer. (For more information about this, see the “Leukeran side effects” section above.) For these reasons, Leukeran may be used after other treatments, if those treatments didn’t work for your CLL.

Your first CLL treatment will depend on a variety of factors, including your age and whether you have any other medical conditions. Leukeran isn’t usually given as a first-choice treatment by itself, except in people who are either older or very ill.

When Leukeran is used as a first-choice treatment, it’s often given in combination with other medications. Examples of other medications that may be used with Leukeran include obinutuzumab (Gazyva) and rituximab (Rituxan).

If you have questions about Leukeran’s effectiveness for CLL treatment, talk with your doctor. They can determine whether Leukeran is a good treatment option for your condition.

Leukeran for lymphoma

Leukeran is a chemotherapy drug that’s FDA-approved to treat certain types of lymphoma. (Chemotherapy describes traditional drugs used to treat cancer.)

Lymphoma is a form of cancer that affects your lymphatic system. (Your lymphatic system is made up of lymph nodes and vessels, as well as a fluid called lymph.) Lymphoma also affects your lymphocytes, which are a certain type of white blood cell.

The two major types of lymphoma are described below:

  • Non-Hodgkin lymphoma (NHL). NHL is the most common form of lymphoma. It encompasses most cancers of the lymphatic system, such as follicular lymphoma (FL) and marginal zone lymphoma (MZL).
  • Hodgkin lymphoma (HL). HL is a less common form of lymphoma. It’s a very specific form of lymphoma that’s diagnosed with certain tests, including imaging tests and blood tests. The key factor used to diagnose HL is the presence of Reed-Sternberg cells (large B lymphocytes, which are a type of white blood cell). These particular cells are only found in people with Hodgkin lymphoma.

Effectiveness for lymphoma

Leukeran is listed in FL treatment guidelines from the National Comprehensive Cancer Network (NCCN). And the National Cancer Institute (NCI) includes Leukeran in their list of drugs approved to treat both Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL).

However, Leukeran isn’t used very often as a first-choice treatment for lymphoma. This is because research has shown that the drug doesn’t lead to better long-term outcomes than other drugs used to treat CLL do. And Leukeran increases the risk of developing certain types of cancer. (For more information about this, see the “Leukeran side effects” section above).

If you have questions about Leukeran’s effectiveness for lymphoma treatment, talk with your doctor. They can recommend whether Leukeran is a good treatment option for your condition.

Off-label uses for Leukeran

In addition to the uses listed above, Leukeran may be used off-label for other purposes. Off-label drug use is when a drug that’s approved for one use is used or under study for a different use that’s not approved. Below is an example of an off-label use for Leukeran.

Leukeran for nephrotic syndrome

Leukeran isn’t FDA-approved to treat nephrotic syndrome, but sometimes it’s used off-label for this condition.

Nephrotic syndrome refers to signs and symptoms that result from kidney damage. With this syndrome, you may have:

Current treatment recommendations from the American Family Physician list Leukeran as a treatment option for certain adults with nephrotic syndrome.

To determine whether Leukeran is right for your condition, your doctor may order a kidney biopsy (sample of tissue). Your doctor may also recommend additional testing for your condition.

If you’d like to know more about using Leukeran to treat nephrotic syndrome, talk with your doctor. They can recommend appropriate treatment options for your condition.

Leukeran and children

Leukeran isn’t FDA-approved for use in children. This is because the safety and effectiveness of the drug hasn’t been studied in people younger than 18 years of age.

However, in some cases, Leukeran is prescribed off-label for use in children. Treatment guidelines from the American Academy of Pediatrics list Leukeran as an option for children with childhood-onset nephrotic syndrome. (This is a type of nephrotic syndrome that begins during childhood and isn’t caused by a drug or other medical condition.)

If you have questions about using Leukeran for your child’s treatment, talk with your doctor.

Leukeran isn’t approved by the Food and Drug Administration (FDA) for use in animals. But sometimes, Leukeran is prescribed for cats with one of the following conditions:

Similar to when it’s used in people, Leukeran can cause certain side effects in cats. These side effects may include:

  • bone marrow suppression, which may lead to blood disorders such as low blood cell counts
  • nausea and vomiting
  • diarrhea

For cats with IBD, Leukeran dosages of 2 mg given once every 2 to 3 days have been used. For IBD, this Leukeran dosage is typically given for 7 to 14 days. And after that, the dosage is adjusted as needed.

For cats with lymphoma, Leukeran dosages are typically 0.1 to 0.2 mg per kg* of body weight per day for 4 to 7 days. Then, a dosage of 0.1 mg/kg per day is given, until their cancer enters remission. (With remission, most or all signs of cancer have disappeared.) So if your cat weighs 5 kg, their dose would be 0.5 to 1 mg daily for the first 4 to 7 days. And then it would be 0.5 mg daily until their cancer went into remission.

If you’d like to know more about using Leukeran for your cat, talk with your cat’s veterinarian. They can recommend treatment options for your cat’s condition that are considered safe and effective in animals.

* One kilogram (kg) is equal to about 2.2 pounds (lb)

Leukeran isn’t approved by the Food and Drug Administration (FDA) for use in animals. But sometimes, Leukeran is used to treat canine lymphoma. This condition is a form cancer that affects the lymphatic system in dogs. (The lymphatic system is made up of lymph nodes and vessels, as well as a fluid called lymph.)

For this use, Leukeran is often given in combination with a corticosteroid, such as prednisone or prednisolone. Studies have shown that this treatment regimen is more effective than either a placebo (no active treatment) or a corticosteroid alone. (In the studies, effectiveness was shown using median survival time. This term describes the length of time that half of the dogs lived after their condition was diagnosed or treatment was started.)

One dosage of Leukeran that’s been used for treating CLL in dogs is 0.1 to 0.2 mg per kg* of body weight per day for 4 to 7 days. Then, a dosage of 0.1 mg/kg per day is given, until their cancer enters remission. (With remission, most or all signs of cancer have disappeared.) So, if your dog weighs 10 kilograms, their dosage would be 1 to 2 mg daily for the first 4 to 7 days. And then it would be 1 mg daily until their cancer went into remission.

It’s hard to predict what side effects Leukeran may cause in dogs. And certain side effects may take some time to occur after treatment with the drug is started. Your dog’s veterinarian may be able to give you an idea of what side effects Leukeran may cause in your dog.

If you have questions about using Leukeran for your dog, talk with your dog’s veterinarian. They can recommend treatment options for your dog’s condition that are considered safe and effective in animals.

* One kilogram (kg) is equal to about 2.2 pounds (lb)

When you get Leukeran from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Leukeran tablets should be stored in a refrigerator at a temperature of 36°F to 46°F (2°C to 8°C). The tablets should be kept in a tightly sealed container.

Disposal

If you no longer need to take Leukeran and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

Leukeran is considered hazardous waste, so it shouldn’t be thrown in the trash or flushed down the toilet. If you need to dispose of Leukeran, call you doctor’s office or pharmacy. The medical staff may be able to take the medication back and dispose of it for you. (If they offer this service, they’ll dispose of the drug according to hazardous waste procedures.)

Also, ask your pharmacist about drug take-back days at your local pharmacy. On these days, you can bring back certain medications for disposal at your pharmacy.

This article provides several useful tips on medication disposal. But you can also ask your pharmacist for information on how to dispose of your medication.

There aren’t any known interactions between Leukeran and alcohol. However, drinking alcohol while taking Leukeran can increase certain side effects of the drug. For example, you may have increased nausea or vomiting.

If you consume large amounts of alcohol while you’re using Leukeran, you may have an increased risk of seizures. And in some cases, you may also have peripheral neuropathy. (With this condition, you have nerve damage that causes numbness or tingling in your hands or feet.)

Keep in mind that alcohol itself is also known to have both short-term and long-term effects on your body.

If you drink alcohol, and you have concerns about drinking while you’re taking Leukeran, talk with your doctor. They can recommend a safe approach for you during treatment with Leukeran.

There haven’t been any interactions reported between Leukeran and other medications, herbs, supplements, or foods.

However, taking Leukeran with other drugs that cause similar side effects may increase your risk of those side effects. And doing so may also make the side effects worse for you. (For more information about the possible side effects of Leukeran, see the section “Leukeran side effects” above.)

To help avoid possible drug interactions, talk with your doctor and pharmacist before starting Leukeran. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

As with all medications, the cost of Leukeran can vary.

The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Your insurance plan may require you to get prior authorization before approving coverage for Leukeran. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the request and let you and your doctor know if your plan will cover Leukeran.

If you’re not sure if you’ll need to get prior authorization for Leukeran, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Leukeran, or if you need help understanding your insurance coverage, help is available.

Medication Assistance Tool provides lists of programs that may help to lower the cost of Leukeran. For more information and to find out if you’re eligible for support, visit the organization’s website.

Generic version

Leukeran isn’t available in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Leukeran, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed below are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternatives for chronic lymphocytic leukemia

Examples of other drugs that may be used to treat chronic lymphocytic leukemia (CLL) include:

Alternatives for lymphoma

Treatment for lymphoma varies depending on the type of lymphoma that’s being treated. Examples of drugs other than Leukeran that may be used to treat lymphoma include:

  • chemotherapy drugs, such as:
    • ifosfamide (Ifex)
    • cisplatin
    • carboplatin
    • oxaliplatin (Eloxatin)
    • fludarabine
    • pentostatin (Nipent)
    • cladribine (Leustatin)
    • cytarabine
    • gemcitabine (Gemzar)
    • doxorubicin
    • vincristine
  • immunotherapy drugs, such as:
    • brentuximab (Adcetris)
    • rituximab (Rituxan)
    • obinutuzumab (Gazyva)
  • targeted therapies, such as:
    • duvelisib (Copiktra)
    • copanlisib (Aliqopa)

You may wonder how Leukeran compares with other medications that are prescribed for similar uses. Here we look at how Leukeran and Imbruvica are alike and different.

Ingredients

Leukeran contains the active drug chlorambucil, while Imbruvica contains the active drug ibrutinib. These drugs belong to different classes of drugs, which means they work in different ways inside your body.

Uses

Leukeran and Imbruvica are both approved to treat a form of blood cancer called chronic lymphocytic leukemia (CLL).

In addition, Leukeran is approved to treat the following conditions:

Imbruvica is also approved to treat these conditions:

It’s important to note that certain types of cancers related to NHL, such as WMG and MZL, may also be treated with Leukeran. However, the Food and Drug Administration (FDA) hasn’t approved Leukeran for these specific purposes.

* CLL and SLL are forms of cancer that affect certain white blood cells. CLL and SLL are very similar types of cancer, and they’re both treated in similar ways.

** Systemic therapy refers to drugs that affect your whole body.

*** With cGVHD, transplanted stem cells attack your body and cause a serious, and sometimes life threatening, condition.

Drug forms and administration

Leukeran comes as tablets that are taken by mouth once each day.

Imbruvica comes as both capsules and tablets. These forms are each taken by mouth once a day.

Side effects and risks

Leukeran and Imbruvica are both used to treat certain forms of cancer. These medications can cause similar side effects and some different ones as well. Below are examples of these side effects.

Your side effects may vary from those listed below, depending on the condition you’re using either drug to treat.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Leukeran, with Imbruvica, or with both drugs (when taken individually).

  • Can occur with Leukeran:
    • muscle weakness
  • Can occur with Imbruvica:
    • bruising or bleeding more than usual
    • fatigue (lack of energy)
    • muscle or joint pain
    • rash
  • Can occur with both Leukeran and Imbruvica:
    • diarrhea
    • nausea or vomiting
    • mouth sores
    • fever
    • muscle spasms

Serious side effects

These lists contain examples of serious side effects that can occur with Leukeran, with Imbruvica, or with both drugs (when taken individually).

* Leukeran has a boxed warning regarding the risk of fetal harm, infertility, increased risk of cancer, and bone marrow suppression, which may lead to blood disorders. A boxed warning is the strongest warning required by the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

Effectiveness

Leukeran and Imbruvica have different approved uses, but they’re both used to treat CLL and certain types of lymphoma.

The use of Leukeran and Imbruvica in treating CLL has been directly compared in a clinical study. In this study, 82.4% of people taking Imbruvica had their cancer go away, either completely or partially. In comparison, 35.3% of people taking Leukeran had the same result.

The study also showed that about 43% of people taking Leukeran had their disease worsen with treatment. In comparison, about 9% of people taking Imbruvica had the same outcome.

Costs

Leukeran and Imbruvica are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

You can view cost estimates for these medications on GoodRx.com, But keep in mind that the actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

You may wonder how Leukeran compares with other medications that are prescribed for similar uses. Here we look at how Leukeran and Calquence are alike and different.

Ingredients

Leukeran contains the active drug chlorambucil, while Calquence contains the active drug acalabrutinib. These drugs belong to different classes of drugs, which means they work in different ways inside your body.

Uses

Leukeran and Calquence are both approved to treat a form of blood cancer called chronic lymphocytic leukemia (CLL).

In addition, Leukeran is approved to treat the following conditions:

In addition to CLL, Calquence is approved to treat these conditions:

* For MCL, Calquence received accelerated approval from the FDA. Accelerated approval is based on information from early clinical trials. The FDA’s decision for full approval will be made after additional clinical trials are completed.

** CLL and SLL are forms of cancer that affect certain white blood cells. CLL and SLL are very similar types of cancer, and they’re both treated in similar ways.

Drug forms and administration

Leukeran comes as tablets that are taken by mouth once each day.

Calquence comes as capsules that are also taken by mouth. But unlike Leukeran, this drug is taken twice each day.

Side effects and risks

Leukeran and Calquence are both used to treat certain forms of cancer. These medications can cause similar side effects and some different ones as well. Below are examples of these side effects.

Your side effects may vary from those listed below, depending on the condition you’re using either drug to treat.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with each drug, or with both Leukeran and Calquence (when taken individually).

  • Can occur with Leukeran:
    • mouth sores
    • fever
    • muscle problems, such as spasms and weakness
  • Can occur with Calquence:
    • headache
    • upper respiratory tract infections
    • muscle or joint pain
    • bruising more than usual
  • Can occur with both Leukeran and Calquence:
    • nausea or vomiting
    • diarrhea

Serious side effects

These lists contain examples of serious side effects that can occur with Leukeran, with Calquence, or with both drugs (when taken individually).

* Leukeran has a boxed warning regarding the risk of fetal harm, infertility, increased risk of cancer, and bone marrow suppression, which may lead to blood disorders. A boxed warning is the strongest warning required by the Food and Drug Administration (FDA). Boxed warnings alert doctors and patients about drug effects that may be dangerous.

Effectiveness

Leukeran and Calquence have different approved uses, but they’re both used to treat CLL and certain types of lymphoma.

The use of Leukeran and Calquence in treating CLL has been directly compared in a clinical study. This study compared treatment with Calquence plus obinutuzumab (Gazyva) to treatment with Leukeran plus Gazyva. And the study also looked at treatment with Calquence alone.

Compared with people taking Leukeran plus Gazyva, people taking Calquence plus Gazyva reduced their risk of dying or having their cancer get worse by 90%. And compared with people taking Leukeran plus Gazyva, people taking Calquence alone reduced their risk of dying or having their cancer get worse by 80%.

Costs

Leukeran and Calquence are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

You can view cost estimates for these medications on GoodRx.com. But keep in mind that the actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

You should take Leukeran according to your doctor’s or healthcare provider’s instructions.

When to take

Different dosages of Leukeran may be prescribed depending on the condition that’s being treated. Usually, Leukeran is taken once daily for a few weeks. But this isn’t always the case. Sometimes, Leukeran is taken only once every two weeks or once monthly.

For more information about dosing schedules for Leukeran, see the section “Leukeran dosage” above. And talk with your doctor about how often you’ll need to take this medication during treatment.

To help make sure that you don’t miss a dose of Leukeran, try setting a reminder on your phone. A medication timer may be useful, too.

Can Leukeran be crushed, split, or chewed?

Leukeran shouldn’t be crushed, split, or chewed.

This is because Leukeran is a chemotherapy drug. And these drugs are generally considered harmful to handle.

Talk with your doctor or pharmacist about how to safely handle Leukeran while you’re taking it. And if you have trouble swallowing Leukeran tablets, talk with your doctor or pharmacist about safe ways to make doing so easier for you.

Leukeran is approved to treat certain types of the following forms of cancer:

With cancer, abnormal (cancer) cells quickly multiply in certain areas of your body. (Cells that multiply are making more cells.)

Leukeran works by slowing cancer cells from multiplying. And the drug also works by killing the cancer cells. While Leukeran doesn’t cure cancer, it can slow the disease from worsening.

How long does it take to work?

Leukeran begins to work after your first dose of the drug. But you may not notice any changes in symptoms caused by your cancer.

This is because Leukeran slows your cancer from worsening. But it doesn’t necessarily treat symptoms of cancer.

Depending on the type of cancer you have, your doctor may order certain tests to see if Leukeran is working for you. In some cases, this may include certain blood or imaging tests.

Talk with your doctor about how’ll they’ll monitor your progress during Leukeran treatment.

It’s not considered safe to take Leukeran during pregnancy. This is because the drug may cause harm to a developing fetus.

In fact, the Food and Drug Administration (FDA) has placed a boxed warning on Leukeran regarding the risk of fetal harm. A boxed warning is the strongest warning required by the FDA. Boxed warnings alert doctors and patients about drug effects that may be dangerous.

Leukeran hasn’t been studied in pregnant women. But the drug has caused certain kidney problems in fetuses when it was used during the first trimester of pregnancy. And in animal studies, certain birth defects were seen in fetuses exposed to the drug. But keep in mind that animal studies don’t always predict what will happen in people.

It’s best to avoid becoming pregnant when you’re taking Leukeran. If you’re sexually active and able to become pregnant, talk with your doctor about how to prevent pregnancy while you’re taking Leukeran. For more information about this, see the section “Leukeran and birth control” below.

If you do become pregnant during Leukeran treatment, call your doctor right away. They will likely recommend that you stop taking Leukeran. But their recommendation will depend on your unique situation.

Infertility caused by Leukeran

Leukeran may cause infertility (inability to get pregnant or cause pregnancy) in some people. In fact, FDA has placed a boxed warning on Leukeran regarding the risk of infertility. A boxed warning is the strongest warning required by the FDA. Boxed warnings alert doctors and patients about drug effects that may be dangerous.

Chlorambucil (the active drug in Leukeran) has caused both reversible and irreversible infertility in some people using the drug.

If you have concerns about becoming infertile with Leukeran treatment, talk with your doctor. They can discuss with you the risk and benefits of treatment.

It’s not considered safe to take Leukeran during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control options while you’re using Leukeran.

It’s not known whether Leukeran passes into human breast milk. But it’s possible that the drug could cause risks to a child who’s breastfed.

For this reason, it’s important to talk with your doctor before breastfeeding if you’re taking Leukeran. Your doctor can discuss with you safe and healthy ways to feed your child.

Here are answers to some frequently asked questions about Leukeran.

Will Leukeran cure my condition?

No, Leukeran won’t cure leukemia (cancer that affects certain white blood cells) or lymphoma (cancer that affects your lymphatic system). And at this time, there’s actually no known cure for cancer.

However, Leukeran can help slow your cancer from worsening and spreading in your body. If you’d like to know more about the effectiveness of Leukeran to treat your condition, see the section “Leukeran uses” above. And be sure to talk with your doctor about what you can expect with treatment.

Can I take Leukeran after I’ve had radiation therapy?

Yes, you may be able to if your doctor recommends it. However, Leukeran is usually not recommended for use within 4 weeks of radiation therapy. This is because taking it within that period of time can increase your risk of bone marrow damage.

Your bone marrow makes all your body’s blood cells. With damaged bone marrow, you may have a decreased levels of red blood cells, white blood cells, or platelets.

In some cases, your doctor may recommend that you take Leukeran before 4 weeks have passed after radiation therapy. This may be the case if your radiation therapy was used in areas of your body that are further away from your bone marrow.

If you have questions about using Leukeran after having radiation, talk with your doctor.

Will I need any lab tests while I’m taking Leukeran?

Yes, your doctor will order certain blood tests for you during Leukeran treatment. This allows your doctor to monitor for certain side effects of the drug, such as blood disorders. Typical blood tests that will be ordered will check your levels of platelets, white blood cells, and red blood cells.

In addition, your doctor may order other blood tests to check the health of your liver.

If you have questions about the lab tests you’ll need during Leukeran treatment, talk with your doctor.

If I’m due for vaccines, can I get them during Leukeran treatment?

That depends on the type of vaccine you need to have. During Leukeran treatment, your doctor will recommend that you avoid getting live vaccines. (These vaccines contain small amounts of live virus.)

This is because Leukeran may lower your level of white blood cells. Having fewer white blood cells may decrease the ability of your immune system to fight off infections. This means that if you get a live vaccine, you may develop the infection the vaccine was meant to protect you from.

Examples of live vaccines that should be avoided during Leukeran treatment include:

In general, live vaccines should be avoided in people with weakened immune systems. But there may be certain vaccines that you’re able to take during Leukeran treatment.

If you have questions about vaccines you can receive during Leukeran treatment, talk with your doctor. They can recommend which vaccines are safe for you to take while you’re using this drug.

Is it safe for older adults to use Leukeran?

Yes, it may be. But it’s important to note that clinical studies of Leukeran didn’t include very many people ages 65 years and older. So it’s not known for sure if older people respond differently to Leukeran than younger people do.

However, Leukeran is often recommended for use in older people. This is because the drug is sometimes better tolerated by older people than other treatments are.

If you’re 65 years of age or older, your doctor may start you on a dosage of Leukeran that’s lower than the typical dosage. And they may monitor you more closely than usual during treatment by ordering certain lab tests.

If you have questions about Leukeran’s safety given your age, talk with your doctor. They can discuss with you the risks and benefits of treatment.

This drug comes with several precautions.

FDA warnings

This drug has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

  • Bone marrow suppression. Leukeran may decrease the ability of your bone marrow to produce blood cells. This may lead to low levels of red blood cells, white blood cells, and platelets. In some cases, bone marrow suppression may increase your risk of anemia, infections, and bruising or bleeding more often than usual. During treatment with Leukeran, your doctor will check your blood cell counts to monitor for bone marrow suppression.
  • Increased risk of cancer. Even though Leukeran is used to treat cancer, the drug may also increase your risk of developing certain types of cancer. Research has shown that people taking chlorambucil (the active drug in Leukeran) have an increased risk of acute myeloid leukemia (AML). (AML is a type of cancer that affects your blood or bone marrow.) Because of this risk, Leukeran is only approved for treating chronic lymphocytic leukemia (CLL) and certain types of lymphoma.
  • Possible harm to fetuses. Leukeran is likely a teratogenic drug, which means it may cause harm to developing fetuses. Because of this, Leukeran should not be used during pregnancy.
  • Infertility. Leukeran may cause infertility (inability to get pregnant or cause pregnancy) in both males and females using the drug. In some cases, the infertility may be temporary; in other cases, it may be permanent.

Other precautions

Before taking Leukeran, talk with your doctor about your health history. Leukeran may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Allergy to Leukeran. You should avoid taking Leukeran if you’ve had an allergic reaction in the past to this drug or other drugs called alkylating agents. If you’re unsure about your medication allergies, talk with your doctor.
  • Low level of white blood cells or platelets. Before starting Leukeran, if you have a low level of white blood cells or platelets, your doctor may recommend that you wait until your level improves before you take this drug. Leukeran may cause new or worsening blood disorders, including low levels of white blood cells and platelets. Talk with your doctor about your blood cell counts before starting treatment with Leukeran.
  • Recent radiation therapy. If you’ve had radiation therapy within the past 4 weeks, your doctor will likely recommend that you wait to start Leukeran until it’s been 4 weeks since your radiation. An exception is if the radiation was given in an area of your body that’s away from your bone marrow. In that case, your doctor may not postpone Leukeran treatment. Both radiation and Leukeran can suppress the activity of your bone marrow. Using these therapies too closely together can be dangerous for your health. Tell your doctor about any radiation therapy that you’ve had before starting Leukeran.
  • Liver problems. Leukeran can cause liver damage in some people. If you already have liver problems, tell your doctor before taking Leukeran. They may recommend that you take a dosage of Leukeran that’s lower that the typical dosage. Or they may recommend a treatment other than Leukeran for you.
  • Seizures. Leukeran can cause seizures in some people. If you have a history of seizures or brain injuries, tell your doctor before taking Leukeran. Also, tell your doctor about any other medications you’re taking. (Your risk of seizures may be increased if you’re taking certain other medications that increase your risk for seizures.) Your doctor may recommend that you avoid taking Leukeran with other drugs that also increase your risk of seizures. The risk of seizures is also increased in people who get “pulse” doses of Leukeran. (Pulse doses of Leukeran are given once every 2 weeks or once monthly.) So, if you have a history of seizures or head trauma, your doctor may recommend a different dosage schedule of Leukeran for you.
  • Pregnancy. Leukeran is not recommended for use during pregnancy. For this reason, it’s recommended that pregnancy be avoided during treatment with this drug. For more information, please see the “Leukeran and pregnancy” and “Leukeran and birth control” sections above.
  • Breastfeeding. Leukeran hasn’t been studied in breastfeeding women. Talk to your doctor before using Leukeran if you plan to breastfeed or are currently breastfeeding. For more information, please see the “Leukeran and breastfeeding” section above.

Note: For more information about the potential negative effects of Leukeran, see the “Leukeran side effects” section above.

Using more than the recommended dosage of Leukeran can lead to serious side effects. Do not use more Leukeran than your doctor recommends.

Overdose symptoms

Symptoms of an overdose can include:

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

The following information is provided for clinicians and other healthcare professionals.

Indications

Leukeran is indicated for treatment of the following conditions in adults:

  • chronic lymphocytic leukemia (CLL)
  • certain types of non-Hodgkin lymphoma (NHL), such as follicular lymphoma (FL)
  • Hodgkin lymphoma (HL)

Leukeran is not approved for use in children at this time. Safety and effectiveness of the drug have not been proven in this population.

Administration

Leukeran is supplied as a tablet and is administered orally. Dosing recommendations vary depending on the condition being treated. This drug can be given daily, once every 2 weeks, or once monthly. Review current prescribing recommendations for each indication for additional recommendations.

Mechanism of action

Leukeran is an alkylating agent (nitrogen mustard class) that interferes with DNA replication. It also causes apoptosis of cancer cells via buildup of cytosolic p53 and activation of Bax.

Metabolism

Leukeran is largely metabolized by the liver. People with decreased liver function should be monitored closely during treatment, and reduced dosages may be considered. Renal excretion is minimal, and dosage adjustments based on renal impairment are not recommended at this time.

Contraindications

Leukeran should not be given to people with previous hypersensitivity reactions to Leukeran or other alkylating agents. Additionally, this drug should be avoided by people with conditions that have shown previous resistance to Leukeran treatment.

Storage

Leukeran tablets should be stored in a refrigerator, at a temperature of 36° to 46°F (2° to 8°C), in a tightly sealed container.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.