Fludarabine in Nonmalignant Disorders

This chapter discusses our experience with the use of fludarabine in the treatment of immune-mediated renal diseases, and skin and joint diseases. Lymphocyte targeting therapies have provided important insights into the pathogenesis and treatment of autoimmune diseases and may help to better understand the effects of fludarabine on autoimmune diseases. The evolution from autoimmunity to lymphoid malignancies is most striking in the case of patients with Sjogren’s syndrome. Membranous nephropathy is a common cause of immune complex-mediated nephrotic syndrome in adults and accounts for about 20% of cases of adult onset nephrotic syndrome. Several long-term prospective studies have revealed significant decline in function over time in the majority of rheumatoid arthritis patients and significant costs estimated to be more than $29,000 per case in 1990 dollars. Psoriatic arthritis occurs in approximately 5–25% of patients with psoriasis and may present as peripheral arthritis, central or axial arthritis, or a combination of both.