Cutaneous adverse reaction to 2-chlorodeoxyadenosine with histological flame figures in patients with chronic lymphocytic leukaemia.

INTRODUCTION: 2-Chlorodeoxyadenosine (cladribine or 2-CdA) is a purine analogue that has been used successfully in hairy cell leukaemia (HCL). Moreover, it has been increasingly used to treat chronic lymphoproliferative syndromes and paediatric acute myeloid leukaemia. Cutaneous side-effects associated with this drug have seldom been described in cases of HCL. PATIENTS AND METHODS: We describe three patients with chronic lymphocytic leukaemia that presented generalized skin eruptions after treatment with 2-CdA. RESULTS: All patients had advanced disease, receiving 2-CdA as a second or third line chemotherapy. Skin lesions were severe and chemotherapy had to be discontinued. Histological examination of skin biopsies showed an eosinophil-rich infiltrate with flame figures, similar to what is observed in Wells' syndrome (eosinophilic cellulitis). Corticosteroids were effective to control the eruptions. CONCLUSIONS: Cutaneous adverse reactions associated with 2-CdA have seldom been observed in the treatment of HCL. However, as this purine analogue has been used in more advanced cases these may be more frequent and severe. The pathophysiology of these lesions is unclear, but it is probably related to drug-induced change in T-cell imbalance in severely immunosuppressed patients.

Changes in AgNOR configurations during the evolution and treatment of chronic lymphocytic leukemia.

The evolution of the pattern of nucleolar organiser regions (AgNORs) in circulating lymphocytes during the stable phase and after chemotherapy in CLL was analysed. Peripheral blood smears were stained by the AgNOR technique at diagnosis, during observation follow-up in stable phase, or at the beginning and at the end of chemotherapy in patients with progressive disease. The changes in the AgNOR pattern were compared with those of TTM used as a tumour burden parameter. Among 52 cases that entered the study, 29 were in stable phase and 23 had progressive disease and received chemotherapy. During stable phase, the AgNORs as well as TTM remained constant. In treated patients, the relative reduction of tumour mass was correlated with a decrease in the percentage of lymphocytes containing one AgNOR cluster. The percentage of cells with one compact nucleolus before chemotherapy was inversely correlated with the relative amount of tumor reduction after treatment. We conclude that the AgNOR pattern in CLL describes the cell kinetic changes during the evolution of the disease and is a prognostic factor for tumor reduction after treatment.