Fludarabine Disease Interactions

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

Life-threatening and sometimes fatal autoimmune hemolytic anemia has been reported in patients with and without previous history of autoimmune hemolytic anemia or a positive Coombs' test during fludarabine therapy. Risk factors that predispose patients to this complication have not been identified. Patients should be instructed to immediately report signs and symptoms suggesting anemia such as fatigue, weakness, and/or bloody urine. Therapy with fludarabine should be administered cautiously in patients with anemia and those with a history of or a predisposition to hemolytic syndromes. Close clinical monitoring of hematopoietic function for hemolysis and anemia is recommended.

Fludarabine can severely suppress bone marrow function. Leukopenia, thrombocytopenia, and anemia have been reported during fludarabine therapy. Patients should be instructed to immediately report any signs or symptoms suggesting bone marrow suppression such as fever, sore throat, local infection, or bleeding. Therapy with fludarabine should be administered cautiously in patients with bone marrow suppression. Close clinical monitory of hematopoietic function is recommended.

Peripheral neuropathy has been reported in patients during fludarabine therapy. Therapy with fludarabine should be administered cautiously in patients with a history of or predisposition to neuropathy.

Fludarabine is primarily eliminated by the kidney and it should be administered cautiously in patients with renal insufficiency. Patients with moderate impairment of renal function (creatinine clearance 30 to 70 mL/min/1.73 m2) should have their fludarabine dose reduced by 20% and be monitored closely. Fludarabine is not recommended for patients with severely impaired renal function (creatinine clearance less than 30 mL/min/1.73 m2).

Transfusion- associated graft-versus-host disease has been observed rarely after transfusion of non-irradiated blood in fludarabine treated patients. Consideration should, therefore, be given to the use of irradiated blood products in those patients requiring transfusions while undergoing treatment with fludarabine.