毒理性
在临床试验中,仅有小部分使用氟达拉滨治疗白血病的患者出现了血清酶升高的情况。从这些研究中,氟达拉滨与其他用于白血病治疗方案的抗肿瘤药物相比,其作用并不总是明确的。已经报道了因氟达拉滨导致临床上明显的肝损伤的病例,但详细信息很少,且大多数患者还在接受其他癌症化疗药物。
氟达拉滨具有免疫抑制作用,能降低总白细胞计数,特别是淋巴细胞计数和CD8 T细胞。因此,氟达拉滨治疗与慢性乙型肝炎的再激活案例有关,包括在一个化疗前已经解决了乙型肝炎的患者中,出现HBsAg的发展和活动性疾病的情况,表现为存在抗-HBc但无HBsAg。再激活通常发生在3到6个疗程的抗癌药物之后,大多数在完成化疗后2到4个月。氟达拉滨治疗后再激活的频率和严重性使得建议在治疗前对患者进行HBsAg和抗-HBc的筛查,并使用对HBV具有强效活性的口服核苷类似物,如拉米夫定、替诺福韦或恩替卡韦进行预防性抗病毒治疗。如果没有使用预防措施,则需要仔细监测并及时进行抗病毒治疗。氟达拉滨还与机会性感染的发展有关,包括肝的疱疹病毒和腺病毒感染。
可能性评分:E*(尚未证实但怀疑是临床上明显肝损伤的原因)。
In clinical trials, serum enzymes elevations occurred in only a small proportion of patients treated with fludarabine for leukemia. The role of fludarabine as opposed to other antineoplastics used in antileukemic regimens was not always clear from these studies. Cases of clinically apparent liver injury due to fludarabine have been reported to occur, but few details were available and most patients were receiving other cancer chemotherapeutic agents.
Fludarabine is immunosuppressive and decreases total white blood cell counts and specifically lymphocyte counts and CD8 T cells. As a consequence, fludarabine therapy has been linked to cases of reactivation of chronic hepatitis B, including instances of reverse seroconversion marked by development of HBsAg and active disease in a patient who had resolved hepatitis B before chemotherapy, as shown by presence of anti-HBc without HBsAg. Reactivation typically occurs after 3 to 6 courses of anticancer mediations and most commonly 2 to 4 months after completing chemotherapy. The frequency and severity of reactivation after fludarabine therapy has led to recommendations that patients be screened for HBsAg and anti-HBc before treatment, and give prophylaxis with antiviral therapy using an oral nucleoside with potent activity against HBV, such as lamivudine, tenofovir or entecavir. If prophylaxis is not used, careful monitoring and early institution of antiviral therapy is warranted. Fludarabine has also been associated with development of opportunistic infections including herpes virus and adenovirus infection of the liver.
Likelihood score: E* (Unproven but suspected cause of clinically apparent liver injury).
来源:LiverTox