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Leuk Res. 2013 Sep;37(9):986-94. doi: 10.1016/j.leukres.2013.05.004. Epub 2013 Jun 17.

Fludarabine: a review of the clear benefits and potential harms.

Author information

1
Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland, OH, USA.

Abstract

BACKGROUND:

Fludarabine successfully treats chronic lymphocytic leukemia (CLL); however, its use may lead to significant myelosuppression and other toxicities. This article weighs the benefits against potential harms, highlighting strategies for appropriate patient selection and administration.

METHODS:

Relevant studies were identified upon literature review, which were combined with our clinical and institutional experience.

RESULTS:

Fludarabine-based regimens result in an overall response rate of approximately 95% and of untreated CLL patients. Fludarabine also causes potentially irreversible grade 3 or 4 cytopenias and infection in the majority of patients. Furthermore, future hematopoietic cell mobilization may be difficult and secondary myelodysplastic syndrome and leukemia occur in at least 3% of patients.

CONCLUSION:

Fludarabine should be used judiciously in older patients, and avoided entirely in patients with renal insufficiency. Close monitoring of blood cell counts with appropriate dose reduction/omission is vital. Finally, alternatives such as pentostatin and bendamustine should be considered.

KEYWORDS:

Adverse effects; Fludarabine; Myelosuppression; Secondary malignancy; Toxicities

PMID:
23787174
DOI:
10.1016/j.leukres.2013.05.004
[Indexed for MEDLINE]

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