Concurrent cytomegalovirus and pneumocystis pneumonia after fludarabine therapy for chronic lymphocytic leukemia

To the Editor: 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.  . .