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Autoimmune thrombocytopenia due to chronic lymphocytic leukemia treated with fludarabine
Tiffany Wells1, Michael J Kovacs
1University of Western Ontario, London, Ontario, Canada.
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 10(3)/mm(3). Four weeks later, the platelet level was below 10 x 10(3)/mm(3). At that time, the woman was treated with fludarabine. The platelet count 4 weeks later was normal (270 x 10(3)/mm(3)) 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.