Fludarabine (Fludara)

Indications

  • Acute Myeloid Leukemia (AML) (see Acute Myeloid Leukemia, [[Acute Myeloid Leukemia]]): as part of FLAG regimen (fludarabine + cytarabine + G-CSF)
  • Chronic Lymphocytic Leukemia (CLL) (see Chronic Lymphocytic Leukemia, [[Chronic Lymphocytic Leukemia]]): higher response rates than alkylating agents or chlorambucil alone
  • Conditioning for Bone Marrow Transplant (BMT)/Stem Cell Transplant (SCT) (see Bone Marrow Transplant, [[Bone Marrow Transplant]]): due to its immunosuppressive effects
  • Non-Hodgkin’s Lymphoma (see Lymphoma, [[Lymphoma]]): indicated for indolent lymphomas

Pharmacology

  • Nucleoside (Purine) Analogue

Administration

  • PO:
  • IV:

Dose Adjustments

  • Hepatic
  • Renal

Adverse Effects

Pulmonary Adverse Effects

Diffuse Alveolar Hemorrhage (DAH) (see Diffuse Alveolar Hemorrhage, [[Diffuse Alveolar Hemorrhage]])

  • Pathology: absence of pulmonary capillaritis (bland alveolar hemorrhage)

Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia, [[Drug-Induced Pulmonary Eosinophilia]])

  • Epidemiology: case reports

Pneumocystis Jirovecii Infection (see Pneumocystis Jirovecii, [[Pneumocystis Jirovecii]])

  • Increased Risk When Used in Intensive Treatment Regimen for Autologous Bone Marrow Transplant (BMT)/Stem Cell Transplant (SCT) (see Bone Marrow Transplant, [[Bone Marrow Transplant]])
  • Increased Risk When Used in Combination with Cyclophosphamide (Cytoxan) (see Cyclophosphamide, [[Cyclophosphamide]])

Pneumonitis (see Pneumonia, [[Pneumonia]], Lung Nodule or Mass, [[Lung Nodule or Mass]], and Interstitial Lung Disease-Etiology, [[Interstitial Lung Disease-Etiology]])

  • Epidemiology: occurs in 8.6% of cases
  • Diagnosis
    • CXR/Chest CT: alveolar infiltrates, mixed alveolar-interstitial infiltrates, or nodular infiltrates
  • Treatment: withdraw drug + corticosteroids

Other Adverse Effects

  • xxx
  • xxx
  • xxx

References

  • Eosinophilic pneumonia after administration of fludarabine for the treatment of non-Hodgkin’s lymphoma. Ann Hematol. 2002 Sep;81(9):535-7 [MEDLINE]