Page 188 - Essential Haematology

174 / Chapter 12 Haematological malignancy: management

Table 12.1 Drugs used in the treatment of leukaemia and lymphoma.

Mechanism of action Particular side - effects *
Alkylating agents
Bendamustine Alylating agent and purine Myelosuppression
analogue
Cyclophosphamide Cross - link DNA, impede RNA Haemorrhagic cystitis,
formation cardiomyopathy, loss of hair
Chlorambucil Marrow aplasia, hepatic toxicity,
dermatitis
Busulfan Marrow aplasia, pulmonary
fi brosis, hyperpigmentation
Melphalan Marrow aplasia
Nitrosoureas (BCNU, CCNU) Renal and pulmonary toxicity
Cisplatin Intrastrand DNA linkage Renal dysfunction, neurotoxicity,
ototoxicity
Antimetabolites
Hydroxycarbamide (hydroxyurea) Inhibits ribonucleotide Pigmentation, nail dystrophy,
reductase skin ulceration
Methotrexate Inhibit pyrimidine or purine Mouth ulcers, gut toxicity
synthesis or incorporation
into DNA
Cytosine arabinoside Inhibits DNA synthesis CNS especially cerebellar
toxicity and conjunctivitis at
high doses
†
†

6 - Mercaptopurine , 6 - thioguanine Purine analogue Jaundice, gut toxicity

Clofarabine Purine analogue Myelosuppression
Fludarabine Inhibit adenosine deaminase Immunosuppression (low CD4
2 - Chlorodeoxyadenosine or other purine pathways counts); renal and
Deoxycoformycin neurotoxicity (at high doses)
Cytotoxic antibiotics
Anthracyclines (e.g. Bind to DNA and interfere Cardiac toxicity, hair loss
daunorubicin) with mitosis
Hydroxodaunorubicin
(Adriamycin)
Mitoxantrone
Idarubicin
Bleomycin DNA breaks Pulmonary fi brosis, skin
pigmentation
Plant derivatives
®
Vincristine (Oncovin ) Spindle damage Neuropathy (peripheral or
bladder or gut)
Vinblastine myelosuppression
Vindesine
Etoposide Mitotic inhibitor Hair loss, oral ulceration