Guidance on the use of fludarabine for B-cell chronic lymphocytic leukaemia

Oral fludarabine is recommended as second line therapy for B-cell chronic lymphocytic leukaemia (CLL) for patients who have either failed, or are intolerant of, first line chemotherapy, and who would otherwise have received combination chemotherapy of either:

• cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP)

• cyclophosphamide, doxorubicin and prednisolone (CAP) or

• cyclophosphamide, vincristine and prednisolone (CVP)

The oral formulation of fludarabine is preferred to the intravenous formulation on the basis of more favourable cost effectiveness. Intravenous fludarabine should only be used when oral fludarabine is contraindicated.