Joshua Lukenbill1, Matt Kalaycio. 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.
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 CLLpatients. 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.
Authors: Bhalchandra Mirlekar; Daniel Michaud; Samuel J Lee; Nancy P Kren; Cameron Harris; Kevin Greene; Emily C Goldman; Gaorav P Gupta; Ryan C Fields; William G Hawkins; David G DeNardo; Naim U Rashid; Jen Jen Yeh; Autumn J McRee; Benjamin G Vincent; Dario A A Vignali; Yuliya Pylayeva-Gupta Journal: Cancer Immunol Res Date: 2020-02-05 Impact factor: 11.151
Authors: Thomas J Kipps; Freda K Stevenson; Catherine J Wu; Carlo M Croce; Graham Packham; William G Wierda; Susan O'Brien; John Gribben; Kanti Rai Journal: Nat Rev Dis Primers Date: 2017-01-19 Impact factor: 52.329
Authors: Christina D Drenberg; Alice A Gibson; Stanley B Pounds; Lei Shi; Dena P Rhinehart; Lie Li; Shuiying Hu; Guoqing Du; Anne T Nies; Matthias Schwab; Navjotsingh Pabla; William Blum; Tanja A Gruber; Sharyn D Baker; Alex Sparreboom Journal: Cancer Res Date: 2017-02-16 Impact factor: 12.701
Authors: Clara J K Lam; Rochelle E Curtis; Graça M Dores; Eric A Engels; Neil E Caporaso; Aaron Polliack; Joan L Warren; Heather A Young; Paul H Levine; Angelo F Elmi; Joseph F Fraumeni; Margaret A Tucker; Lindsay M Morton Journal: J Clin Oncol Date: 2015-08-03 Impact factor: 44.544