Fludarabine (Fludara)

General information

Class/mechanism: Purine analog, antimetabolite; fludarabine is converted to the active compound, 2-fluoro-ara-ATP, which inhibits DNA synthesis by inhibiting DNA polymerase alpha, ribonucleotide reductase, and DNA primase. Relatively resistant to deamination by adenosine deaminase. The mechanism of action is not completely characterized and may be multi-faceted.^[1]^[2]
Route: IV, PO Note: Oral fludarabine is no longer available in the US, at this time.
Extravasation: neutral

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.^[1]

Diseases for which it is established (work in progress)

Non-Hodgkin lymphoma

Diseases for which it is used

Diseases for which it was used

Patient drug information

History of changes in FDA indication

1991-04-18: Initial FDA approval for the treatment of patients with B-cell chronic lymphocytic leukemia (CLL) who have not responded to or whose disease has progressed during treatment with at least one standard alkylating-agent containing regimen. (Based on Grever et al. 1990 & Keating et al. 1989)

History of changes in EMA indication

1994-08-11: EURD

History of changes in PMDA indication

2007-01-26: New route of administation and additional indications for treatment of low-grade B-cell non-Hodgkin lymphoma and mantle cell lymphoma.
2008-05-20: New indication and a new dosage for use as a conditioning prior to allogeneic hematopoietic stem cell transplantation in the following diseases: acute myeloid leukemia, myelodysplastic syndrome, chronic myeloid leukemia, chronic lymphocytic leukemia, malignant lymphoma, and multiple myeloma.
2009-11-06: New additional indication for the treatment of chronic lymphocytic leukemia with anemia or thrombocytopenia.
2009-11-06: New additional indications and a new dosage for the treatment of recurrent or refractory low-grade B-cell non-Hodgkin’s lymphoma and mantle cell lymphoma.
2019-03-26: New indication for the treatment prior to tumor-specific T-cell infusion therapy.
2022-06-20: New indication and a new dosage for the treatment of relapsed or refractory acute myeloid leukemia.

Also known as

Generic names: FAMP, fludarabine phosphate
Brand names: Beneflur, Fludabine, Fludara, Lymfuda, Oforta

References

[insert-1] 1.0 ^1.1 ^1.2 Fludarabine (Fludara) package insert

[2] Fludarabine (Fludara) package insert (locally hosted backup)

[3] Fludarabine (Fludara) patient drug information (Chemocare)

[4] Fludarabine (Fludara) patient drug information (UpToDate)

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