Pca. Shepherd et al., SEVERE CYTOPENIAS ASSOCIATED WITH THE SEQUENTIAL USE OF BUSULFAN AND INTERFERON-ALPHA IN CHRONIC MYELOID-LEUKEMIA, British Journal of Haematology, 86(1), 1994, pp. 92-96
We describe four patients who developed severe thrombocytopenia which
progressed to aplasia after the use of alpha-interferon in maintenance
therapy of chronic phase CML after busulphan induction. On reviewing
over 400 patients in the MRC CML III. trial we found that there is a r
isk of cytopenia developing after busulphan therapy and a lesser risk
of cytopenias developing after alpha-interferon therapy. If the therap
ies are given in a sequential fashion the risk of cytopenia developing
appears to be additive, may be pronounced, and map lead to clinically
significant problems. Hydroxyurea alone does not lead to sustained cy
topenia. Care should be taken to ensure that counts are stable after t
he use of busulphan before starting alpha-interferon as maintenance th
erapy.