Fludarabine

Abstract

S Fludarabine Pneumonitis: case reportA 55-year-old woman developed pneumonitis after receiving fludarabine for stage IV non-Hodgkin follicular lymphoma.The woman received IV fludarabine 25 mg/m 2 for 3 days every 28 days, as well as mitoxantrone and dexamethasone. Two weeks after the last cycle of chemotherapy, she was admitted to a haematology department with dyspnoea and fever [duration of treatment to reaction onset not clearly stated]. Chest x-rays revealed bilateral pneumofibrotic changes, and chest CT showed bilateral diffuse interstitial changes and fibrotic changes in the lower part of the lungs. Tests showed a CRP level of 47 mg/L.The woman did not respond to empiric antibacterial therapy. Further analysis excluded Mycoplasma pneumoniae and Pneumocystis jiroveci infections, as well as sarcoidosis and systemic rheumatic disease. Her reduced carbon monoxide transfer factor (TLCO) was 45%. She was diagnosed with pneumonitis; fludarabine was suspected to be the cause. Antibacterials were withdrawn, and she began receiving prednisolone. Subsequently, her dyspnoea, fever and the diffuse interstitial changes in her lungs resolved; her TLCO was 75%. Fludarabine was not restarted.Author comment: "The findings, including fever, moderate CRP level, diffuse interstitial changes with bilateral fibrotic alterations in the lungs, and a reduced TLCO led to the diagnosis of pneumonitis, and the suspected cause was fludarabine." Rudzianskiene M, et al. Corticosteroid-responsive pulmonary toxicity associated with fludarabine monophosphate: A case report. Turkish Journal of Hematology 29: 392-396, No. 4, 2012. Available from: URL: http://dx.