DELAYED ALLERGIC REACTION TO CHLORAMBUCIL (LEUKERAN(R))

A 63-year-old man developed a mild hemorrhagic diathesis which led to the diagnosis of chronic lymphatic leukemia. Treatment with prednisone and chlorambucil was initiated. During the first 10 day-cycle (10 mg chlorambucil and 100 mg prednisone) no side effects were noted. On the 8th day of second cycle (10 mg chlorambucil and 25 mg prednisone) the patient noticed fever, tiredness, myalgia, pruritus and erythema on t he skin. The third cycle (10 mg chlorambucil alone) hat to be stopped on the second day due to the development of myalgia, generalized eryth roderma with exfoliation and edema of the face and arms. In the patch- test with chlorambucil, a strongly positive (histologically verified) allergic reaction was noted. A lymphocyte stimulation test (detecting in vitro lymphocytes sensitized to chlorambucil) was also positive. Th ese findings, together with the marked clinical reaction to chlorambuc il alone, led to the diagnosis of a delayed hypersensitivity reaction to chlorambucil. Such well documented allergic reactions to chlorambuc il are very rarely described in the literature. Up to now only 1 case of immune hemolytic anemia, 1 case of Lyell-syndrome, 2 cases of delay ed hypersensitivity reactions and a few cases of less well documented type I reactions have been described. In all these cases no crossreact ivity with other alkylating agents occurred, and hence all patients co uld be successfully treated with cyclephosphamide.