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. 2012 Dec;29(4):392-6.
doi: 10.5505/tjh.2012.50490. Epub 2012 Dec 5.

Corticosteroid-responsive pulmonary toxicity associated with fludarabine monophosphate: a case report

Milda Rudzianskiene  1 , Rasa Griniute  1 , Elona Juozaityte  1 , Arturas Inciura  1 , Viktoras Rudzianskas  1 , Greta Emilia Kiavialaitis  1
Affiliations

Corticosteroid-responsive pulmonary toxicity associated with fludarabine monophosphate: a case report

Milda Rudzianskiene et al. Turk J Haematol. 2012 Dec.

Abstract
in English, Turkish

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.

Fludarabin monofosfat lenfoid malignansilerin tedavisinde etkin bir ilaçtır. Fludarabinin en sık görülen yan etkileri myelosupresyon, fırsatçı enfeksiyonlar ve otoimmün hemolitik anemidir. Burada evre IV non-Hodgkin foliküler lenfoma için FMD (fludarabin, mitoksantron ve deksametazon) kemoterapisinin üçüncü kürünü tamamladıktan sonra ateş ve dispneyle gelen 55 yaşında bir kadını bildiriyoruz. Akciğer röntgeninde bilateral pnömofibrotik değişiklikler varken göğüs BT’de fibrotik değişikliklerle bilateral difüz interstisyel değişiklikler görüldü. Herhangi bir enfeksiyöz ajan bulgusu saptanmadı. Hastanın karbonmonoksit transfer faktörü azalmıştı (%45). Belirtileri ve radyografik bulguları prednizolon tedavisiyle geçti. Literatürde steroid tedavisine cevap veren, fludarabinle ilişkili birkaç interstisyel pulmoner toksisite olgusu vardır. Fludarabin tarafından indüklenen pulmoner toksisite ilacın kesilmesi ve glukokortikosteroidlerin uygulanmasıyla geri çevrilebilir.

Keywords: Fludarabine monophosphate; Pulmonary toxicity; non-Hodgkin lymphoma.

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Figures

Figure 1
Figure 1. Bilateral pneumofibrotic changes in the chest X ray
Figure 2
Figure 2. Chest CT: bilateral diffuse interstitial changes with fibrotic alterations in the lower parts of the lungs.
Figure 3
Figure 3. Chest X-ray showed complete resolution of diffuse interstitial changes after prednisolone therapy.
See this image and copyright information in PMC

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