FATAL BONE-MARROW NECROSIS FOLLOWING FLUDARABINE ADMINISTRATION IN A PATIENT WITH INDOLENT LYMPHOMA

We report the first known case of fulminant bone marrow necrosis (BMN) occurring after infusion of fludarabine monophosphate in a patient wi th recurrent low-grade non-Hodgkin's lymphoma (NHL). Extensive BMN is characterized by the development of fever, bony pain, a leukoerythrobl astic peripheral blood film, variable de of pancytopenia and elevation s in lactate dehydrogenase and alkaline phosphatase. The diagnosis of BMN is rarely entertained ante-mortem. Although the precise role chemo therapy may have played in triggering fatal BMN remains speculative, w e alert clinicians to be aware of this entity as more patients with in dolent lymphomas and leukemias are treated with this and other potent nucleoside analogs.