A purine-analogue chemotherapy for certain blood cancers
Fludarabine
A chemotherapy medicine used to treat certain blood cancers such as chronic lymphocytic leukaemia and some lymphomas.
What is Fludarabine?
Fludarabine is a chemotherapy medicine, one of a group called purine analogues, used to treat certain blood cancers, especially chronic lymphocytic leukaemia and some lymphomas. It works by interfering with the DNA of cancer cells so they cannot grow and multiply. Its most important effect is a profound and long-lasting weakening of the immune system, which raises the risk of serious and unusual infections for many months, so people on it need protection against infection and any blood transfusions must be specially treated (irradiated). It also lowers blood counts and, rarely at high doses, can cause serious effects on the nervous system. It is given only under specialist cancer care.
Education and reference only. This is a plain-language guide to Fludarabine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Fludarabine is a chemotherapy medicine in a group known as purine analogues, used mainly to treat chronic lymphocytic leukaemia (a cancer of certain white blood cells) and some types of lymphoma. It can be given as an injection or infusion into a vein, or as tablets, and is also used as part of the preparation for some stem-cell (bone-marrow) transplants. It is a powerful specialist medicine, prescribed and supervised by a cancer specialist team, with careful monitoring throughout treatment.
How it works
Fludarabine resembles one of the building blocks the body uses to make DNA. Cancer cells take it up by mistake and try to use it, but it jams the machinery that copies and repairs DNA, so the cells cannot multiply and are pushed to die. Because the cancers it treats involve white blood cells (lymphocytes) that are central to the immune system, fludarabine also strongly suppresses these normal immune cells, which is why it weakens the immune defences so deeply and for so long. This same action on dividing cells in the bone marrow explains why it lowers blood counts.
Company & origin
Originated / developed by: Specialist manufacturers.
A specialist chemotherapy medicine used in the UK to treat certain blood cancers, particularly chronic lymphocytic leukaemia and some lymphomas.
Practical use
How to take Fludarabine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given as an injection or drip into a vein, or as tablets, strictly as arranged by your cancer team.
- Report any sign of infection, such as fever, chills, sore throat or feeling unwell, straight away.
- Make sure any healthcare professional knows you have had fludarabine, as blood transfusions must use specially treated (irradiated) blood.
- Take any protective medicines against infection exactly as your team prescribes them.
- Attend all blood tests and appointments so your blood counts and recovery can be checked.
Weighing it up
Advantages & disadvantages of Fludarabine
Advantages
- An effective treatment for chronic lymphocytic leukaemia and some lymphomas.
- Can be given as a drip into a vein or as tablets, and used in transplant preparation.
- A well-established option within specialist blood-cancer treatment.
Disadvantages
- Causes profound and long-lasting weakening of the immune system, raising the risk of serious infections.
- Lowers blood counts, which can cause anaemia, bleeding and a high infection risk.
- Rarely, especially at high doses, can cause serious effects on the nervous system.
Practical use
Good to know
The dominant safety issue with fludarabine is its profound and prolonged effect on the immune system: it deeply lowers the white blood cells that fight infection, and this can last for many months after treatment, leaving people vulnerable to serious and unusual (opportunistic) infections. Because of this, protective antibiotic-type medicines are often given, and crucially, any blood transfusion must use specially treated (irradiated) blood to prevent a rare but very dangerous reaction. Fludarabine also suppresses the bone marrow more generally, lowering red cells and platelets as well, so blood counts are watched closely. Rarely, and particularly at higher doses, it can cause serious effects on the nervous system. People are advised to report any sign of infection straight away and to follow all the protective measures the team puts in place.
Who should not take it / use with caution
- People who have had a serious allergic reaction to fludarabine should not use it.
- It is avoided in pregnancy and breastfeeding, as chemotherapy can harm the baby.
- It is used with great care, or avoided, in people with significant kidney problems or active serious infection.
- It should only be used under specialist cancer care, with full supportive measures in place.
Monitoring
- Regular blood tests to check blood counts and watch for infection.
- Checking kidney function and overall wellbeing throughout treatment.
- Watching for signs of infection and, rarely, nervous-system effects.
Side effects
- A profound and prolonged drop in infection-fighting white cells, raising the risk of serious and unusual infections.
- A drop in red cells and platelets, causing tiredness, breathlessness, bruising or bleeding.
- Nausea, vomiting, diarrhoea or feeling generally unwell.
- Rarely but seriously, severe effects on the nervous system (especially at high doses) or a dangerous immune reaction if non-irradiated blood is given.
Key interactions
- Other medicines that lower blood counts or weaken the immune system add to the risk and must be reviewed.
- Some medicines and live vaccines must be avoided because of the weakened immune system.
- Tell your cancer team about every medicine and supplement, as interactions can be serious.
Available as: A solution given into a vein, or tablets taken by mouth.
Answers
Fludarabine: frequently asked questions
What is fludarabine used for?
It is a chemotherapy medicine used to treat certain blood cancers, particularly chronic lymphocytic leukaemia and some lymphomas, and in preparation for some stem-cell transplants.
Why does it raise my infection risk so much?
It deeply and lastingly lowers the white blood cells that fight infection, so people can be vulnerable to serious and unusual infections for many months after treatment.
Why must my blood transfusions be irradiated?
Fludarabine weakens the immune system so much that ordinary donated blood could trigger a rare but very dangerous reaction; specially treated (irradiated) blood prevents this.
What should I do if I feel unwell?
Report any sign of infection, such as fever, chills or feeling unwell, to your team straight away, as infections can become serious quickly.
Can it affect the nervous system?
Rarely, and particularly at high doses, fludarabine can cause serious effects on the nervous system, so the team monitors for this.
The wider class
About Cytotoxic chemotherapy (purine analogue)
Fludarabine belongs to the cytotoxic chemotherapy (purine analogue) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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