Fludarabine for prolymphocytic leukaemia and risk of interstitial pneumonitis

Cervantes, Francisco; Salgado, Camino; Montserrat, Emilio; Rozmán, C

doi:10.1016/0140-6736(90)92606-i

Cited by 38 publications

(10 citation statements)

References 3 publications

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“…In two, an attributable cause was found (CMV and RSV), but in two other cases, no etiological agent was identified. Case reports of interstitial pneumonitis consistent with druginduced pulmonary injury have been published in patients treated with fludarabine [25,26]. All of these patients responded to corticosteroid therapy.…”

Section: Discussionmentioning

confidence: 99%

FLAG (fludarabine, high-dose cytarabine, and G-CSF) for refractory and high-risk relapsed acute leukemia in children

McCarthy

Pitcher

Hann

et al. 1999

Med. Pediatr. Oncol.

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Background The treatment of relapsed and refractory leukemia in children remains a challenge. The morbidity of further chemotherapy is considerable, as most patients have already been exposed to intensive multiagent chemotherapy. The FLAG (fludarabine, high‐dose cytarabine, and G‐CSF) regimen is as intensive but less cardiotoxic because of the avoidance of anthracyclines. Procedure Nineteen children were treated in two U.K. centers with the FLAG regimen for relapsed and refractory acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). There were 13 males and 6 females, with an age range of 1.9 to 14.2 years. AML was the diagnosis in 12 children, ALL in 4, biphenotypic leukemia in 3. Eight patients had refractory disease, 11 were in relapse (5 in first relapse, 4 in second, and 2 in third). Results Complete remission was obtained in 13 patients, partial remission was obtained in 4, and 2 patients were considered nonresponders. There were seven patients alive at 12 months (mean) posttherapy; one of these is awaiting bone marrow transplantation (BMT). All patients experienced grade 4 hematological toxicity; no patient died of infection. Thirteen patients received BMT as consolidation (seven unrelated donor; six sibling allografts). Six of these have died, four due to pneumonitis. Conclusions FLAG can be regarded as an effective protocol for inducing remission in a group of heavily pretreated children. Its toxicity is acceptable due to the avoidance of anthracyclines. Med. Pediatr. Oncol. 32:411–415, 1999. © 1999 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

FLAG (fludarabine, high-dose cytarabine, and G-CSF) for refractory and high-risk relapsed acute leukemia in children

McCarthy

Pitcher

Hann

et al. 1999

Med. Pediatr. Oncol.

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“…In rare cases, respiratory manifestations seem to be related to a pulmonary hypersensitivity reaction to the drug, or to a toxic side effect [3,13]. We hypothesize that the so-called, allergic, toxic, or interstitial pneumonitis in CLL patients receiving fludarabine might correspond in some cases to RSV infections; therefore, this possibility should be systematically ruled out in these patients.…”

Section: Discussionmentioning

confidence: 97%

Severe respiratory syncytial virus pulmonary infection in a patient treated with fludarabine for chronic lymphocytic leukemia

Eftekhari

Lassoued

Oksenhendler

et al. 1998

Annals of Hematology

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Fludarabine phosphate is currently proposed for the treatment of refractory chronic lymphocytic leukemia (CLL). CD4 T-lymphocyte depletion, myelosuppression, and subsequent severe infections are the major side effects of fludarabine phosphate therapy. We report here on a heretofore undescribed respiratory syncytial virus (RSV) infection in a patient with a long-standing history of refractory CLL that was treated with fludarabine phosphate. The patient developed a severe infection of the upper and lower respiratory tract with bilateral pulmonary infiltrates and severe hypoxemia. RSV was the only infectious agent that could be isolated, and treatment with aerosolized ribavirin lead to prompt improvement of all symptoms.

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“…Helman et al conducted a retrospective analysis of 105 patients with chronic lymphoproliferative diseases that were treated with fludarabine or fludarabine-containing regimens, and reported an 8.6% incidence of fludarabine-associated pulmonary toxicity [12]. The literature includes several case reports of interstitial pneumonitis related to fludarabine therapy [4,5,6,7,8,13]. In all cases the patients had non-productive cough, dyspnea, and fever, which typically began 1-2 weeks after the last course of chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…A relationship between the number of chemotherapy cycles and the development of pneumonitis was not established. In the four previous cases patients presented with the certain degree of hypoxia [4,5,8,13]. Garg et al reported a patient with no signs of hypoxia [7].…”

Section: Discussionmentioning

confidence: 99%

Corticosteroid-Responsive Pulmonary Toxicity Associated with Fludarabine Monophosphate: A Case Report

Rudžianskienė¹,

Griniūtė²,

Juozaitytė³

et al. 2012

Turk J Hematol

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Fludarabine monophosphate is an effective drug for the treatment of lymphoid malignancies. Myelosuppression, opportunistic infections, and autoimmune hemolytic anemia are the most common side effects of fludarabine. Herein we report a 55-year-old female that presented with fever and dyspnea after completing her third cycle of FMD (fludarabine, mitoxantrone, and dexamethasone) chemotherapy for stage IV non-Hodgkin follicular lymphoma. Chest X-ray revealed bilateral pneumofibrotic changes and chest CT showed bilateral diffuse interstitial changes with fibrotic alterations. No evidence of infectious agents was noted. The patient had a reduced carbon monoxide transfer factor (45%). Her symptoms and radiographic findings resolved following treatment with prednisolone. The literature contains several cases of fludarabine-associated interstitial pulmonary toxicity that responded to steroid therapy. Fludarabine-induced pulmonary toxicity is reversible with cessation of the drug and administration of glucocorticosteroids.Conflict of interest:None declared.

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Fludarabine for prolymphocytic leukaemia and risk of interstitial pneumonitis

Cited by 38 publications

References 3 publications

FLAG (fludarabine, high-dose cytarabine, and G-CSF) for refractory and high-risk relapsed acute leukemia in children

FLAG (fludarabine, high-dose cytarabine, and G-CSF) for refractory and high-risk relapsed acute leukemia in children

Severe respiratory syncytial virus pulmonary infection in a patient treated with fludarabine for chronic lymphocytic leukemia

Corticosteroid-Responsive Pulmonary Toxicity Associated with Fludarabine Monophosphate: A Case Report

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