Bone marrow depression induced by chloramphenicol or phenylbutazone. Leukemia and other sequelae

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Abstract
With 2 registries for adverse drug reactions, a follow-up survey was made of 151 cases reported of bone marrow depression following use of chloramphenicol (124 patients), phenylbutazone (24), or both drugs (3). Leukemia subsequently developed in 3 patients with bone marrow depression attributed to use of chloramphenicol, but only 1 had characteristics suggesting a cause-and effect relationship between drug exposure and leukemia. A review of clinical and epidemiologic information provides inadequate evidence that either drug is leukemogenic. Among other sequelae in the survey were 4 cases of hemolytic anemia; these 4 cases included 2 with paroxysmal nocturnal hemoglobinuria. Several problems arise in evaluating a causal association between drug exposure and diseases such as leukemia.

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