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Interestingly, cladribine is cytotoxic not only to dividing cells, but also to resting cells, suggesting alternative mechanism of action in non-dividing cells such as caspase- dependent (136) and caspase-independent (137) mechanisms, via direct mitochondrial toxicity (137, 138), inhibition of DNA repair (139) and epigenetic alterations (140)

Others are mechanically unstable and cause locking or catching that requires surgical intervention

Atherosclerosis linked to aberrant amino acid metabolism and immunosuppressive amino acid catabolizing enzymes

When to Discontinue Therapy Not every rash requires stopping treatment