Myelofibrosis following treatment with a nitrosourea for malignant glioma

Nitrosoureas are alkylating agents that have been associated with the development of a preleukemic syndrome, secondary acute nonlymphocytic leukemia and a variety of acute and delayed toxicities. Nitrosoureas have activity in the treatment of primary malignant brain tumors. The authors report a patient who developed bone marrow myelofibrosis three years following treatment with radiation therapy and oral CCNU. This is the first case of marrow fibrosis associated with the use of a nitrosourea. Bone marrow myelofibrosis may be another delayed treatment effect of this class of drugs.