Fatal interstitial pneumonitis following high-dose intermittent chlorambucil therapy for chronic lymphocytic leukemia

Abstract

Interstitial lung disease has been reported in association with numerous alkylating agents and other chemotherapeutic drugs. Chlorambucil has only rarely been implicated in this complication. We report a case of a 74-year-old man with chronic lymphocytic leukemia who received high-dose intermittent chlorambucil and prednisone every two weeks. Following several of these courses of therapy, respiratory distress occurred 9 to 12 days after the chlorambucil was given. During the final episode, open lung biopsy was performed and demonstrated typical changes of drug-induced pneumonitis, with interstitial infiltrates and fibrosis and proliferation of type II alveolar lining cells.