Concurrent Cytomegalovirus and Pneumocystis Pneumonia after Fludarabine Therapy for Chronic Lymphocytic Leukemia

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Abstract
Fludarabine (9-β-D-arabinofuranosyl-2-fluoroadenine) has recently been approved with orphan-drug status for therapy of chronic lymphocytic leukemia. The rates of response are 64, 58, and 50 percent, respectively, for chronic lymphocytic leukemia in Rai Stages 0 to II, III, and IV.1 Myelosuppression is dose-related and is more common in the first three courses and in patients who do not respond to treatment.1 , 2 Major infections (pneumonia and septicemia) have been reported in 9 percent of patients, and minor infections in 12 percent.1 Opportunistic infections complicating fludarabine therapy have not been reported. We describe a patient with chronic lymphocytic leukemia treated with fludarabine and prednisone who bad two opportunistic infections and a reversal of the ratio of CD4 to GD8 cells.