Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.
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regimen-monograph
CHLO
Intent
Palliative
Regimen Category
Evidence-Informed
Funding Program
ODB - General Benefit
prednisone
Drugs Used
A - Regimen Name
CHLO Regimen
Chlorambucil
Disease Site
Hematologic - Leukemia - Chronic Lymphocytic (CLL)
Intent
Palliative
Regimen Category
Evidence-Informed :
Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
Rationale and Uses
First line therapy for indolent CLL.
Supplementary Public Funding
chlorambucil
ODB - General Benefit (chlorambucil) (
prednisone
ODB - General Benefit (prednisone) (
B - Drug Regimen
Dose and frequency may vary (refer to local procotols). One option is:
| chlorambucil | 6 mg /m² | PO | Days 1 to 14 |
|
(Outpatient prescription in multiples of 2mg tablets)
May also add:
|
|||
| prednisone | 50 mg | PO (Dosage may vary) | Daily for 5 to 10 days |
|
(Outpatient prescription in multiples of 50mg tablets)
|
|||
E - Dose Modifications
Doses should be modified according to the protocol by which the patient is being treated.
Dosage with toxicity
|
Toxicity and Grade
|
Action
|
Dose when Restart
|
|
Severe myelosuppression/
bone marrow failure
|
Discontinue
|
N/A
|
|
Grade 3 hematologic
|
Hold*
|
↓ by 33%
|
|
Grade 4 hematologic, febrile neutropenia or thrombocytopenic bleeding
|
Hold*
|
↓ by 33% or Discontinue
|
|
Grade 3 non-hematologic
|
Hold*
|
↓ by 33%
|
|
Skin or pulmonary toxicity or
Grade 4 non-hematologic |
Discontinue | N/A |
*Before retreatment, major organ toxicities should recover to ≤ Grade 2, platelets ≥100 x 109/L, and ANC≥ 1.5 x 109/L.
Hepatic Impairment
Adjustment required with severe hepatic impairment, no details found.
Renal Impairment
No adjustment required, but monitor carefully as at increased risk of myelosuppression.
The following dosage adjustments have been used by some clinicians:
|
Creatinine Clearance (mL/min)
|
% Dose
|
|
10-50
|
75%
|
|
<10
|
50%
|
F - Adverse Effects
Refer to chlorambucil, prednisone drug monograph(s) for additional details of adverse effects
| Most Common Side Effects | Less Common Side Effects, but may be |
|
|
H - Drug Administration and Special Precautions
Refer to chlorambucil, prednisone drug monograph(s) for additional details
I - Recommended Clinical Monitoring
Recommended Clinical Monitoring
- CBC; baseline and at each visit
- Baseline and regular renal and hepatic function tests
- Clinical toxicity assessment of infection, bleeding, GI, pulmonary, skin, CNS toxicity; at each visit
Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
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K - References
Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed. Philadelphia, PA: American College of Physicians; 2007, p 98.
Chlorambucil drug monograph, Cancer Care Ontario.
Ezdinli E Z, Stutzman L. Chlorambucil therapy for lymphomas and chronic lymphocytic leukemia. JAMA 191: 100-106 (1965).
October 2017 Replaced regimen category with evidence-informed
M - Disclaimer
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.
Last Updated: July 21, 2026
