Fludarabine Phosphate Injection

• Type: Anticancer medication

• Drug Class: Purine analog / Antimetabolite chemotherapy

• Form: Sterile solution or lyophilized powder for intravenous (IV) injection or infusion

How It Works

• Fludarabine phosphate is converted in the body to fludarabine triphosphate, its active form.

• This compound interferes with DNA synthesis by:

  • Inhibiting DNA polymerase and ribonucleotide reductase

  • Causing chain termination during DNA replication

• This leads to cell cycle arrest and apoptosis (cell death), particularly affecting rapidly dividing lymphocytes.

Common Uses

Fludarabine phosphate is mainly used for hematologic (blood-related) cancers, including:

• Chronic lymphocytic leukemia (CLL) – standard first-line or relapsed treatment

• Non-Hodgkin’s lymphoma (NHL) – especially low-grade lymphomas

• Hairy cell leukemia

• Acute leukemias (in combination regimens, less commonly)

• Conditioning regimens for bone marrow or stem cell transplantation (immunosuppressive effect)

Advantages

• Highly effective in CLL and other lymphoid malignancies

• Can be combined with cyclophosphamide and rituximab (FCR regimen) for better outcomes

• Has immunosuppressive properties useful in transplantation protocols

Possible Side Effects

Common:

• Bone marrow suppression (neutropenia, anemia, thrombocytopenia)

• Increased risk of infections

• Fever, fatigue, weakness

• Nausea, vomiting

Serious / Important:

• Severe immunosuppression → risk of opportunistic infections (Pneumocystis pneumonia, CMV reactivation)

• Autoimmune complications (autoimmune hemolytic anemia)

• Neurologic toxicity at very high doses (confusion, seizures, coma)

• Secondary cancers with long-term use (rare)

Precautions

• Regular blood counts are mandatory during treatment

• Prophylaxis against opportunistic infections (like PCP) is often recommended

• Avoid use with live vaccines during and after treatment (immunosuppression)

• Dose adjustment required in renal impairment (drug is renally excreted)

• Careful monitoring for autoimmune hemolysis or other immune complications