Severe bone marrow failure associated with the use of alternating steroid with chlorambucil in lupus membranous nephropathy in Chinese

Severe pancytopenia associated with the use of alternating steroid with chl orambucil regimen was described in six patients with nephrotic syndrome sec ondary to lupus membranous nephropathy (WHO class V). We believe this is th e first report describing the life-threatening degree of marrow toxicity as sociated with this regimen of alternating steroid with chlorambucil in a Ch inese population. Our data suggests that the susceptibility to marrow toxic ity with the use of chlorambucil may only be applicable to Chinese patients with underlying systemic lupus erythematosus as a similar degree of toxici ty has neither been reported in lupus patients of other ethnic groups nor i n non-lupus patients of Chinese origin.