Clinical experience with fludarabine in indolent non-Hodgkin's lymphoma

Fludarabine, a purine nucleoside analog, is currently indicated for the first-line treatment of chronic lymphocytic leukemia and is also licensed for the management of indolent non-Hodgkin's lymphoma (NHL) in countries such as Switzerland and Canada. Clinical evidence from studies in patients with NHL suggests that fludarabine monotherapy is at least as effective, if not better, than conventional therapies such as cyclophosphamide, vincristine, prednisone (CVP) for the first- and second-line treatment of NHL, achieving objective response rates of 31-84%. The combination of fludarabine with other chemotherapeutic agents such as cyclophosphamide or mitoxantrone also provides the clinician with additional useful treatment options in this setting. Objective response rates of 70-100% have been reported with fludarabine-containing combination regimens, often exceeding those reported with CVP. Furthermore, beneficial effects on overall and progression-free survival have been reported with fludarabine or fludarabine-containing combination regimens in a number of studies, including a significant survival benefit with the combination of fludarabine, cyclophosphamide, mitoxantrone and rituximab. While adverse events such as granulocytopenia, neutropenia and anemia and, less frequently, infectious complications have been reported with fludarabine, its adverse event profile generally compares favorably with that of other available treatment options. Available clinical data therefore indicate that fludarabine has an important role to play in the treatment of patients with indolent NHL. Further, studies are warranted to identify the optimal fludarabine regimen for this patient group.