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Reversible Neurologic Toxicity in Patients Treated with Standard-Dose Fludarabine Phosphate for Mycosis Fungoides and Chronic Lymphocytic Leukemia

Roger B. Cohen, MD; Jorge M. Abdallah, MD; James R. Gray, LCDR, MS, USNR; and Francine Foss, MD
[+] Article and Author Information

From the National Naval Medical Center and the National Cancer Institute, Bethesda, Maryland. Requests for Reprints: Roger B. Cohen, MD, NCI/Navy Medical Oncology Branch, National Naval Medical Center, Bethesda, MD 20889.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1993;118(2):114-116. doi:10.7326/0003-4819-118-2-199301150-00007
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Fludarabine phosphate is approved for the treatment of advanced B-cell chronic lymphocytic leukemia refractory to alkylating agents. We report two cases of disabling but reversible neurotoxicity in a patient with mycosis fungoides and a patient with chronic lymphocytic leukemia who received standard doses of fludarabine (20 to 25 mg/m2 per day for 5 days) every 28 days for 6 to 8 cycles. Serial brain magnetic resonance imaging scans in the patient with mycosis fungoides showed rapid evolution of white-matter changes with subsequent complete resolution.

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Grahic Jump Location
Figure 1.
Serial magnetic resonance T2-weighted spin echo scans of brain in Patient 1.(top left)(top right)(bottom left)(bottom right)

A subtle abnormality in white matter is seen in the high temporoparietal area on the left on the initial scan , becoming much more extensive with right-sided involvement as well 6 weeks later , beginning to improve 2 weeks later , and resolving completely 6 weeks later , 3 months after the original scan. At no point was there cortical involvement.

Grahic Jump Location

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