Fludarabine: a review of the clear benefits and potential harms

Leuk Res. 2013 Sep;37(9):986-94. doi: 10.1016/j.leukres.2013.05.004. Epub 2013 Jun 17.


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.

Keywords: Adverse effects; Fludarabine; Myelosuppression; Secondary malignancy; Toxicities.

Publication types

  • Review

MeSH terms

  • Humans
  • Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy*
  • Leukemia, Myeloid, Acute / drug therapy*
  • Myelodysplastic Syndromes / drug therapy*
  • Prognosis
  • Vidarabine / analogs & derivatives*
  • Vidarabine / therapeutic use


  • Vidarabine
  • fludarabine