SEVERE AUTOIMMUNE HEMOLYTIC-ANEMIA IN 8 PATIENTS TREATED WITH FLUDARABINE

We have used fludarabine to treat 36 patients with various lymphoid ma lignancies, including 29 with chronic lymphocytic leukemia (CLL). All these patients were heavily pretreated, and FAMP was prescribed on a c ompassionate basis. Eight patients (22%) developed severe autoimmune h emolytic anemia (AIHA) during or after treatment, and one died. Five p atients had no previous history of hemolysis. These cases confirm the high incidence of AIHA after FAMP and suggest that the use of highly e ffective lymphocytotoxic agents such as fludarabine in heavily pretrea ted patients increases the risk of AIHA in CLL and other lymphoprolife rative disorders.