Fludarabine (Fludara) is a fluorinated purine analogue of the antiviral agent vidarabine. The active metabolite,

2-fluoro-ara-adenosine triphosphate, inhibits various enzymes involved in DNA synthesis, including DNA polymerase-a, ribonucleotide reductase, and DNA primase. Unlike most antimetabolites, it is toxic to nonpro-liferating as well as dividing cells, primarily lymphocytes and lymphoid cancer cells.

The drug is highly active in the treatment of chronic lymphocytic leukemia, with approximately 40% of patients achieving remissions after previous therapy with alkylating agents has failed. Activity is also seen in the low-grade lymphomas.

The major side effect is myelosuppression, which contributes to fevers and infections in as many as half of treated patients. Nausea and vomiting are mild. Occasional neurotoxicity has been noted at higher doses, with agitation, confusion, and visual disturbances.

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