title: Fludarabine: a review of the clear benefits and potential harms.
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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Lukenbill
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
mesh_terms: D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D009190:Myelodysplastic Syndromes / Q000188:drug therapy*; D011379:Prognosis; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D014740:Vidarabine; C024352:fludarabine
keywords: Adverse effects; Fludarabine; Myelosuppression; Secondary malignancy; Toxicities