Description
Chlorambucil, approved by the Food and Drug Administration
(FDA) in 1957, is an antineoplastic/alkylating agent with
a broad spectrum of antitumor activity used to treat chronic
lymphocytic leukemia (CLL), Hodgkin’s and non-Hodgkin’s
lymphomas.
Chemical Properties
beige powder
Chemical Properties
Chlorambucil is a crystalline solid
Originator
Leukeran,BurroughsWellcome,US,1957
Uses
antineoplastic, alkylating agent
Uses
Chlorambucil-d8 is the isotope labelled analogue of Chlorambucil (C324050), an alkylating agent that is used in the treatment of chronic lymphocytic leukemia. Chlorambucil is also used to treat non-Ho
dgkin's lymphoma (NHL) and Hodgkin's disease.
Uses
Chlorambucil is a alkylating agent that is used as an chemotherapy drug in the treatment of chronic lymphocytic leukemia. Chlorambucil is also used to treat non-Hodgkin's lymphoma (NHL) and Hodgkin's
disease.
Definition
ChEBI: A monocarboxylic acid that is butanoic acid substituted at position 4 by a 4-[bis(2-chloroethyl)amino]phenyl group. A chemotherapy drug that can be used in combination with the antibody obinutuzumab for the treatment of chronic lymphocytic leukemia.
Indications
Chlorambucil (Leukeran) is an aromatic nitrogen mustard
that is intermediate in chemical reactivity between
mechlorethamine and melphalan. Its mechanisms of action
and range of antitumor activity are similar to theirs.
It is well absorbed orally, but detailed information concerning
its metabolic fate in humans is lacking.
Chlorambucil is used primarily as daily palliative
therapy for chronic lymphocytic leukemia, Waldenstr?om’s
macroglobulinemia, myeloma, and other lymphomas.
Bone marrow toxicity is the major side effect of
chlorambucil. Nausea is uncommon or mild, and hair
loss does not occur. Chlorambucil shares the immunosuppressive,
teratogenic, and carcinogenic properties of
the nitrogen mustards.
Manufacturing Process
Acetanilide and maleic acid are condensed to give beta-(p-acetaminobenzoyl)
acrilic acid which is hydrogenated to give methyl-gamma-(p-aminophenyl)
butyrate. That is reacted with ethylene oxide and then with phosphorus
oxychloride to give the methyl ester which is finally hydrolyzed to give
chlorambucil.
brand name
Leukeran
(GlaxoSmithKline.
Therapeutic Function
Antineoplastic
General Description
Chlorambucil is available as 2-mg tablets for oral administrationin the treatment of Hodgkin’s lymphoma, andchronic lymphocytic leukemia in combination with prednisoneand as a single agent. The mechanisms of resistanceare the same as those seen for other agents of the class suchas mechlorethamine. The agent is well absorbed (75%) uponoral administration and highly protein bound. Metabolism ismediated by CYP and occurs extensively to give severalmetabolites, including the active phenylacetic acid–nitrogenmustard. The drug is eliminated via the kidneys with a terminalelimination half-life of 1.5 hours. Adverse effects includedose-limiting myelosuppression, which are seen asboth leucopenia and thrombocytopenia. Nausea and vomitingoccur less often than for mechlorethamine. Additionaladverse effects include hyperuricemia, azoospermia, amenorrhea,seizures, pulmonary fibrosis, and skin rash.
General Description
White to pale beige crystalline or granular powder with a slight odor. Melting point 65-69°C.
Air & Water Reactions
Insoluble in water.
Reactivity Profile
Chloroambucil is an alkylating agent. Reacts with proteins and a variety of nucleophilic compounds .
Fire Hazard
Literature sources indicate that Chloroambucil is nonflammable.
Biochem/physiol Actions
Chlorambucil is an anti-cancer drug that alkylates DNA and induces apoptosis. Death of chronic lymphocytic leukemia cells occurs via a p53-dependent mechanism.
Clinical Use
It is used in the palliative treatment of chronic lymphocytic leukemia,
malignant lymphoma, and Hodgkin's disease.
Safety Profile
Confirmed carcinogen producing leukemia. Experimental
carcinogenic and neoplastigenic data. Poison
by ingestion, intravenous, intraperitoneal,
and subcutaneous routes. Human systemic
effects by ingestion: convulsions, cough,
dyspnea, and interstitial fibrosis. Human
reproductive effects by ingestion and
possibly other routes: changes in
spermatogenesis, menstrual cycle changes or
disorders, and teratogenic effects of the fetal
urogenital system. Experimental teratogenic
and reproductive effects. Human mutation
data reported. An anti-neoplastic agent.
When heated to decomposition it emits very
toxic fumes of Cland NOx.
Synthesis
Chlorambucil, 4-[p-[bis-(2-chloroethyl)amino]phenyl]butyric acid (30.2.1.7),
is made from acetanilide and succinic anhydride. In the first stage of synthesis, acetanilide is
acylated by succinic anhydride, giving 4-(4-acetaminophenyl)-4-ketobutyric acid (30.2.1.3).
The keto group in this compound is reduced by hydrogen in a methanol solution using palladium on carbon as a catalyst. This results in the formation of the methyl ester of 4-(4-acetaminophenyl)-butyric acid (30.2.1.4). This is treated with an alkali in order to hydrolyze both
the amide and ester parts of the molecule, which forms 4-(4-aminophenyl)butyric acid
(30.2.1.5), which upon reaction with ethylene oxide gives 4-[p-[bis(2-hydroxyethyl)
amino]phenyl]butyric acid (30.2.1.7). Replacing all of the hydroxyl groups in this compound
using phosphoryl chloride and subsequent treatment with water to hydrolyze the resulting
intermediate acid chloride to an acid gives chlorambucil (30.2.1.7).
Potential Exposure
Chlorambucil, an anticancer drug, is a
derivative of nitrogen mustard. This drug is primarily used
as an antineoplastic agent for treating lymphocytic leukemia; malignant lymphomas; follicular lymphoma; and
Hodgkin’s disease. The treatments are not curative but do
produce some marked remissions. Chlorambucil has also
been tested for treatment of chronic hepatitis, rheumatoid
arthritis; and as an insect chemosterilant. All of the chemical used in this country is imported from the United
Kingdom. Work exposure in the United States would be
limited to workers formulating the tablets, or to those
patients receiving the drug.
Veterinary Drugs and Treatments
Chlorambucil may be useful in a variety of neoplastic diseases, including
lymphocytic
leukemia, multiple myeloma, polycythemia
vera, macroglobulinemia, and ovarian adenocarcinoma.
It may also
be useful as adjunctive therapy for some immune-mediated conditions
(e.g., glomerulonephritis, inflammatory bowel disease, nonerosive
arthritis, or immune-mediated skin disease). It has found
favor as a routine treatment for feline pemphigus foliaceous and
severe feline eosinophilic granuloma complex due to the drug’s relative
lack of toxicity in cats and efficacy.
Drug interactions
Potentially hazardous interactions with other drugs
Ciclosporin: ciclosporin concentration possibly
reduced.
Patients who receive phenylbutazone may require
reduced doses of chlorambucil.
First aid
Skin Contact: Flood all areas of body that havecontacted the substance with water. Do not wait to removecontaminated clothing; do it under the water stream. Usesoap to help assure removal. Isolate contaminated clothingwhen removed to prevent contact by othersEye Contact: Remove any contact lenses at once. Flusheyes well with copious quantities of water or normal salinefor at least 20-30 min. Seek medical attention.Inhalation: Leave contaminated area immediately; breathefresh air. Proper respiratory protection must be supplied toany rescuers. If coughing, difficult breathing or any othersymptoms develop, seek medical attention at once, even ifsymptoms develop many hours after exposure.Ingestion: If convulsions are not present, give a glass ortwo of water or milk to dilute the substance. Assure that theperson’s airway is unobstructed and contact a hospital orpoison center immediately for advice on whether or not toinduce vomiting.
Carcinogenicity
Chlorambucil is known to be a human carcinogen based on sufficient evidence of carcinogenicity from studies in humans.
Environmental Fate
The mechanism of action of chlorambucil is thought to be an
alkylating agent and an aromatic nitrogen mustard derivative; it
interferes with DNA replication and RNA transcription by
alkylation and cross-linking the strands of DNA.
Metabolism
Chlorambucil is extensively metabolised in the liver
via the hepatic microsomal enzyme oxidation system,
principally to phenylacetic acid mustard, which is
pharmacologically active, and which also undergoes some
spontaneous degradation to further derivatives.
Chlorambucil is excreted in the urine, almost exclusively
as metabolites with less than 1% unchanged.
storage
Color Code—Blue: Health Hazard/Poison: Storein a secure poison location. Prior to working with chlorambucil you should be trained on its proper handling and storage. Store in cool, dry place. Store in sealed ampules or inamber screw-capped bottles or vials with Teflon? capliners. Solutions may be stored in bottles or vials with a silicone system having a Teflon? liner and sampled with needle and syringe. Prevent exposure to light. A regulated,marked area should be established where this chemical ishandled, used, or stored in compliance with OSHAStandard 1910.1045.
Shipping
UN2811 Toxic solids, organic, n.o.s., Hazard
Class: 6.1; Labels: 6.1-Poisonous materials, Technical
Name Required.
Purification Methods
Chlorambucil is recrystallised from pet ether (flat needles) and has a solubility at 20o of 66% in EtOH, 40% in CHCl3, 50% in Me2CO but is insoluble in H2O [Everett et al. J Chem Soc 2386 1953]. [Beilstein 14 IV 1715.] CARCINOGEN.
Toxicity evaluation
The chemical is of a white to pale slight odorous powder,
insoluble in water. It is very slightly dispersible in diethyl ether
and acetone. It has a melting point of 69°C, boiling point of
424°C, and 5.75 pKa. The partition coefficient is 4.07 and has
a molecular weight of 304.22 g mol
-1.
Incompatibilities
Moisture. Chlorambucil is an alkylating
agent. Reacts with proteins and a variety of nucleophilic
compounds. Compounds of the carboxyl group react
with all bases, both inorganic and organic (i.e., amines)
releasing substantial heat, water, and a salt that may beharmful. Incompatible with arsenic compounds (releases
hydrogen cyanide gas), diazo compounds, dithiocarbamates, isocyanates, mercaptans, nitrides, sulfides (releasing
heat, toxic, and possibly flammable gases), thiosulfates,
and dithionites (releasing hydrogen sulfate and oxides of
sulfur).
Waste Disposal
It is inappropriate and possibly dangerous to the environment to dispose of expired or
waste drugs and pharmaceuticals by flushing them down
the toilet or discarding them to the trash. Household quantities of expired or waste pharmaceuticals may be mixed
with wet cat litter or coffee grounds, double-bagged in
plastic, discard in trash. Larger quantities shall carefully
take into consideration applicable DEA, EPA, and FDA
regulations. If possible return the pharmaceutical to the
manufacturer for proper disposal being careful to properlylabel and securely package the material. Alternatively, the
waste pharmaceutical shall be labeled, securely packaged,
and transported by a state licensed medical waste contractor
to dispose by burial in a licensed hazardous or toxic waste
landfill or incinerator. Permanganate oxidation, high temperature incineration with scrubbing equipment, or microwave plasma treatment.
