Pharmacotherapy Update: Fludarabine in the Treatment of Non-Hodgkin’s Lymphoma

Fludarabine, a purine nucleoside analogue, is considered as the most active drug in chronic lymphocytic leukemia. This review summarizes current knowledge concerning the mechanism of action, pharmacological properties, clinical activity and toxicity of fludarabine in the treatment of non-Hodgkin’s lymphoma. A literature search on fludarabine for lymphomas was undertaken using MEDLINE databases. Clinical data shows that fludarabine alone and as a component of combination chemotherapy is effective in patients with various types of non-Hodgkin’s lymphoma, particularly in follicular lymphoma. The most commonly used combinations are with cyclophosphamide and/or mitoxantrone. Fludarabine-based regimens are highly active in both previously untreated and relapsed indolent lymphomas. The results of the chemotherapy are considerably improved with the addition of rituximab. Fludarabine is generally well tolerated. Myelosuppression and infections, including opportunistic varieties, are the most frequent adverse effects. Indications for fludarabine and treatment regimens for lymphoma patients are discussed.