Chemotherapy chlorambucil

Dennis, age 10 years, has leukemia and is to begin chemotherapy with chlorambucil (Leukeran). Discuss what information would be important to discuss with Dennis and Ms parents before beginning the treatment regimen. 

A. Bielawska, K. Bielawski, K. Chrzanowski, S. Wolczynski, Prolinase-Activated Prodrug for Cancer Chemotherapy. Cytotoxic Activity of Proline Analogue of Chlorambucil in Breast Cancer MCF-7 Cells , Farmaco 2000, 55, 736-741. 

B = bleomycin, C = chlorambucil, CT = chemotherapy, DFS = disease-free survival, Ep = epirubicin, F = fluorouracil, I = ifosfamide, M = mitomycin C, Mtx = methotrexate, O = vincristine, OS = overall survival, P = cisplatin, RT = radiation therapy, V = vinblastine. 

Bielawska, A., Bielawska, K., Chrzanowski, K., and Wolczynski, S. Prolidase-activated prodrug for cancer chemotherapy cytotoxic activity of praline analogue of chlorambucil in breast cancer MCF-7 cells. II Farmaco 55 736-741, 2000. 

Alkylating agents. Busulfan is a radio-mimetic cytotoxic agent that is effective in PRV, reducing vascular events and delaying myelofibrosis. Its mutagenic potential should restrict its use to older patients. Chlorambucil and combination chemotherapy should be avoided because of excessive leukaemogenic risk. 

Nausea, vomiting and loss of appetite may occur during treatment. Chlorambucil chemotherapy may cause a temporary reduction in the production of blood cells by the bone marrow. Reduction in blood cells can result in anemia, risk of bruising or bleeding, and infection. This effect can begin from 10 to 14 days after the treatment has been given and may last for a few days. The extent to which the blood cell count is reduced depends on the dose of... 

Ever since MOPP therapy was created and the efficacy confirmed, researchers tried to modify the regimen in an attempt to improve efficacy and decrease toxicity. Some MOPP variations include MVPP (vinblastine substituted for vincristine), CVPP (cyclophosphamide substituted for mechlorethamine), and ChlVPP (chlorambucil substituted for mechlorethamine, and vinblastine substituted for vincristine) were attractive alternatives to MOPP because they offered equal efficacy and differing or less severe toxicities. The various combination chemotherapy regimens appear to produce initial complete response rates in over 80% of the patients treated, and result in a 55% to 65% cure rate for advanced Hodgkin s lymphoma. 

Egawa H et al. (1990) Effects of intra-arterial chemotherapy with a new lipophilic anticancer agent estradiol-chlorambucil (KM2210) dissolved in lipiodol on experimental liver tumor in rats. J Surg Oncol 44 109-114 Feldman F et al. (1975) Selective intra-arterial embolization of bone tumors A useful adjunct in the management of selected lesions. Am J Roentgenol Radium Ther Nucl Med 123 130-139... 

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