II. Indications
- Chronic Lymphocytic Leukemia (CLL, FDA approved)
- Non-Hodgkin's Lymphoma
- Acute Myelogenous Leukemia (AML)
- Hematopoietic Stem Cell Transplant conditioning
III. Mechanism
- Nucleotide antimetabolite with antineoplastic activity
- Fludarabine is a fluorinated analog of vidarabine (ara-A), an Antiviral Agent
- Fludarabine is a prodrug, infused as a phosphate salt (Fludarabine phosphate)
- Dephosphorylated to 2-fluoro-ara-A (rapidly on intravenous infusion)
- Intracellularly phosphorylated to the active triphosphate, 2-fluoro-ara-ATP (via deoxycytidine kinase)
- 2-fluoro-ara-ATP inhibits DNA Polymerase, ribonucleotide reductase and DNA primase
- Inhibits tumor cell growth
IV. Medications
- Fludarabine IV Solution in 50 mg vials
V. Adverse Effects
- Myelosuppression
- Progressive Multifocal Leukoencephalopathy
- Lung Toxicity
- Hyperuricemia
- Impaired future fertility
- Alopecia
- Neurotoxicity
- Blindness
- Altered Level of Consciousness (Agitation to coma)
- Autoimmune
- Hemolytic Anemia
- Thrombocytopenia (including Immune Thrombocytopenic Purpura)
- Acquired Hemophilia
- Combined cytopenia (Evan's Syndrome)
VI. Safety
- Avoid in Lactation
- Avoid in pregnancy (all trimesters)
- Use reliable Contraception
- Monitoring