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Fludarabine

The most active single agent in the treatment of chronic lymphocytic leukemia.

Mainly inhibits DNA polymerases.

Inhibits DNA replication and repair and induces apoptosis of primarily lymphocytic cells.

A T cell depleting agent and when combined with steroid causes significant immunosuppression and high incidence of opportunistic infections.

Inhibits the repair of cyclophosphamide induced DNA interstrand crosslinks in CLL cells in vitro, and when used in clinical trials the combination in patients with recurrent disease result in complete remission rate of 10-15% and overall response rate of 60-70% with a median time to progression of 20-25 months.

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