Chlorambucil (Leukeran)

• What chlorambucil is
• How you have treatment
• Common side effects
• Occasional side effects
• Rare side effects
• Important points to remember
• Immunisations and chemotherapy

Chlorambucil is used mainly to treat chronic lymphocytic leukaemia (CLL) and low grade non-Hodgkin’s lymphoma. It is also used to treat Hodgkin's lymphoma. It belongs to a group of drugs called the alkylating agents. Its brand name is Leukeran. It works by sticking to one of the cancer cell's DNA strands. DNA is the genetic code that is in the heart of all animal and plant cells. It controls everything the cell does. The cell cannot then divide into 2 new cells.

Chlorambucil is a brown tablet. You should swallow the tablets whole with plenty of water. Take them half an hour to an hour before food. Keep them in the fridge but away from food. Also keep them away from children. Return any unused tablets to your pharmacy for destruction.

You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for chlorambucil depends on which cancer you are being treated for. There is more information about how chemotherapy is planned in this section of CancerHelp UK.

The side effects associated with chlorambucil are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link please see our chemotherapy side effects section or use the search box at the top of the page.

With this drug, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. 
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion
• Bruising more easily due to a drop in platelets - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia).

These effects on your bone marrow can begin about 7 days after each treatment and usually go back to normal after about 21 to 28 days. Some of these side effects can be life threatening, particularly infections.  You should contact your doctor if you have any of these side effects.  Your doctor will check your blood counts regularly to see how well your bone marrow is working

Other common side effects include

• Fatigue during and after treatment - most people find their energy levels are back to normal within 6 months to a year
• Women may stop having periods (amenorrhoea) but this may only be temporary
• Loss of fertility - you may not be able to get pregnant or father a child after treatment with this drug. It is important to talk to your doctor about fertility before starting treatment.
• Chlorambucil may have a harmful effect on a developing baby - do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant

Some people have the following side effects

• Feeling or being sick - this is usually mild, but if you feel sick let your doctor or nurse know. You can have tablets to prevent this
• Loss of appetite
• Weight loss
• Skin rashes on your face, scalp and body - tell your doctor straight away if you develop a rash. You may have to stop treatment until it gets better.
• Diarrhoea - you should drink plenty of fluids. If diarrhoea becomes severe or continues you could become dehydrated, so let your doctor or nurse know
• Mouth ulcers

A very small number of people have these side effects

• Inflammation of the lungs - tell your doctor if you notice any difficulty breathing
• Fits (seizures) - these are rare, but more likely in children or in people who have had a lot of chlorambucil treatment
• There is a small risk that you may get a second cancer some years after chlorambucil treatment. This occurs in 1 to 10% of people treated.

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Some side effects are inconvenient or upsetting but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because

• Your side effect may need treating
• Your drug dose may need reducing to try to prevent the side effect

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will have given you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy.

It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but no one in the UK is given an oral vaccine now. So there is no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.