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Alert Number 274

Single agent fludarabine: Don't do it

Date: February 10, 2008

I get suspicious when any drug is crowned the de-facto “gold standard” without the necessary clinical trials to back it up.

That has been the case with fludarabine monotherapy.  Don’t get me wrong, fludarabine is still a very potent and important drug in the treatment of CLL.  It is just that too many oncologists use this drug as the slam-dunk choice immediately after diagnosis, with no prognostic testing and no second thought for its appropriateness to the individual patient standing in front of them.  Now the verdict is in:  fludarabine monotherapy greatly increases the chances of potentially life threatening autoimmune disease (AIHA), and it is far safer to use it in combination with other drugs.  The latest article on our website Single Agent Fludarabine spells out the details.

I am sure there are some patients out there reading this review, who have already been there, done that:  patients who were treated with the supposed gold-standard fludarabine, and may have developed AIHA as a consequence.  I can understand your bitterness, your sense of having been let down by the very system that is supposed to protect you.  I am afraid there is no way to undo the past, no way to un-ring the bell that has been rung.  The best you can do is to put it behind you as so much murky water under the bridge and go forward with the determination not to be blind-sided again.

Our review is for the benefit of those that have not yet made these therapy decisions.  It seems the trickle down of hard won knowledge from the experts to the local providers of healthcare takes a good long while.  It will eventually get there, but in the meantime I think it would be a shame if newly diagnosed members of our patient community have to pay for the price for the slow pace.  I will do my best to keep you up to date on the latest information, so that you are ahead of the curve even if your doctor is not.

But no one can be a better advocate for your health than you.  No one has more skin in this game than you.  If you cannot be bothered to learn and watch out for what may come to bite you down the road, who will? Stay tuned, stay informed, and stay proactive.  The life you save will be your own. 

Be well,


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