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

Abstract

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.

Characteristics and outcome of respiratory syncytial virus infection in patients with leukemia

“…7,8,15,19 Most of these studies suffer from relatively small sample size (< 20 patients). Abdallah et al reported on five patients with leukemia who developed RSV patients who were treated with ribavarin patients who were not treated with ribavarin © F e r r a t a S t o r t i F o u n d a t i o n infection (pneumonia in four).…”

“…8,[17][18][19] The few studies reported to date suggest that the epidemiology, clinical course, and response to therapy for RSV infection in leukemia patients mirror the findings in HSCT recipients. 8,17 In leukemia patients, RSV seems to be a frequent cause of life-threatening infection, particularly among elderly patients, and to be associated with persistent myelosuppression, comorbidities, high APACHE II score, and pneumonia.…”

Severe respiratory syncytial virus pneumonia complicating fludarabine and cyclophosphamide treatment of chronic lymphocytic leukemia

“…Fludarabine treatment is clearly associated with an increased risk of other viral infections, such as herpes (simplex and zoster), and cytomegalovirus (7), likely through the development of profound T‐lymphopenia and impaired cell‐mediated immunity, although such therapy has not previously been linked with severe RSV. There is just one prior report of severe RSV pneumonia in a patient with CLL, who had received 10 cycles of single‐agent fludarabine (8).…”

Eosinophilia during fludarabine treatment of chronic lymphocytic leukemia

“…Myelosuppression is the major dose-limiting toxicity [5]. Further adverse effects include moderate nausea and vomiting, persistent reduction in the CD4c cell count associated with an increased incidence of fever and opportunistic infections, neurotoxicity, and autoimmune complications [1,2]. Only two cases of moderate eosinophilia in patients treated with fludarabine have been reported so far, and both patients had centroblastic-centrocytic lymphoma [3].…”