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The Annals of Pharmacotherapy: Vol. 37, No. 5, pp. 671-674. DOI 10.1345/aph.1C287
© 2003 Harvey Whitney Books Company.
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Autoimmune Thrombocytopenia Due to Chronic Lymphocytic Leukemia Treated with Fludarabine

Tiffany Wells, BSc

Medical Student, University of Western Ontario, London, Ontario, Canada

Michael J Kovacs, MD

Hematologist, Department of Hematology, London Health Sciences Centre, London; Associate Professor of Medicine, University of Western Ontario

Reprints: Michael J Kovacs MD, Department of Hematology, Rm. 2760, Phase 1, London Health Sciences Centre, 800 Commissioners Rd., East, London, Ontario N6A 4G5, Canada, FAX 519/685-8477, E-mail michael.kovacs{at}lhsc.on.ca

OBJECTIVE: To report a case of autoimmune thrombocytopenia due to chronic lymphocytic leukemia (CLL) treated with fludarabine.

CASE SUMMARY: A 68-year-old white woman with CLL was treated with oral chlorambucil. She subsequently presented with severe autoimmune thrombocytopenia purpura (ITP). Intravenous gammaglobulin was administered without response, and a therapeutic splenectomy produced only a temporary response, with platelets reaching 65 x 103/mm3. Four weeks later, the platelet level was below 10 x 103/mm3. At that time, the woman was treated with fludarabine. The platelet count 4 weeks later was normal (270 x 103/mm3) and has been sustained for over 22 months.

DISCUSSION: Fludarabine has been reported to be causative in the onset of autoimmune cytopenias with CLL. Our case cautiously suggests fludarabine as a potential treatment for cases of CLL-associated ITP refractory to standard therapy.

CONCLUSIONS: Fludarabine could be considered as treatment of ITP in CLL refractory to standard treatment.

Key Words: chronic lymphocytic leukemia, fludarabine, thrombocytopenia

Published Online, April 3, 2003. www.theannals.com, DOI 10.1345/aph.1C287




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