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Fludarabine

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Fludarabine, Fludara

  • See Also
  1. Antimetabolite Chemotherapy
  2. Chemotherapy
  • Indications
  1. Chronic Lymphocytic Leukemia (CLL, FDA approved)
  2. Non-Hodgkin's Lymphoma
  3. Acute Myelogenous Leukemia (AML)
  4. Hematopoietic Stem Cell Transplant conditioning
  • Mechanism
  1. Nucleotide antimetabolite with antineoplastic activity
  2. Fludarabine is a fluorinated analog of vidarabine (ara-A), an antiviral agent
  3. Fludarabine is a prodrug, infused as a phosphate salt (Fludarabine phosphate)
    1. Dephosphorylated to 2-fluoro-ara-A (rapidly on intravenous infusion)
    2. Intracellularly phosphorylated to the active triphosphate, 2-fluoro-ara-ATP (via deoxycytidine kinase)
    3. 2-fluoro-ara-ATP inhibits DNA Polymerase, ribonucleotide reductase and DNA primase
      1. Inhibits tumor cell growth
  • Medications
  1. Fludarabine IV Solution in 50 mg vials
  • Adverse Effects
  1. Myelosuppression
  2. Progressive Multifocal Leukoencephalopathy
  3. Lung Toxicity
  4. Hyperuricemia
  5. Impaired future fertility
  6. Alopecia
  7. Neurotoxicity
    1. Blindness
    2. Altered Level of Consciousness (Agitation to coma)
  8. Autoimmune
    1. Hemolytic Anemia
    2. Thrombocytopenia (including Immune Thrombocytopenic Purpura)
    3. Acquired Hemophilia
    4. Combined cytopenia (Evan's Syndrome)
  • Safety
  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Renal Function tests
  • Resources
  1. Fludarabine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cf5255cc-91fd-4132-973b-764dba142eae