Generalized purpuric drug exanthem with hemorrhagic plaques following bendamustine chemotherapy in a patient with B-prolymphocytic leukemia
First Online: 31 January 2012 Received: 24 October 2011 Revised: 18 January 2012 Accepted: 19 January 2012 DOI:
Cite this article as: Gavini, A., Telang, G.H. & Olszewski, A.J. Int J Hematol (2012) 95: 311. doi:10.1007/s12185-012-1012-2 Abstract
A 72-year-old woman presented with dyspnea and lower extremity edema. Extreme lymphocytosis, cytopenia, and splenomegaly were found, and she was diagnosed with B-prolymphocytic leukemia. Following the first dose of therapy with bendamustine, the patient developed severe generalized maculopapular rash, which subsequently progressed to exuberant, non-blanching palpable purpura with hemorrhagic plaques suspicious for leukocytoclastic vasculitis. These events coincided with severe chemotherapy-induced neutropenia and thrombocytopenia, but there were no clinical symptoms of infection. Skin punch biopsy revealed perivascular and diffuse upper dermal lymphocytic infiltrate with eosinophils and marked erythrocyte extravasation consistent with a purpuric drug exanthem. The patient was treated with steroids, with complete resolution of the findings. This new form of cutaneous toxicity of bendamustine is presented along with a review of previous experience with the drug.
Keywords Bendamustine Drug eruption Prolymphocytic leukemia Vasculitis Chronic lymphoid leukemia References
Hunder GG, Arend WP, Bloch DA, Calabrese LH, Fauci AS, Fries JF, et al. The American College of Rheumatology 1990 criteria for the classification of vasculitis. Introduction. Arthritis Rheum. 1990;33:1065–7.
Dungarwalla M, Matutes E, Dearden CE. Prolymphocytic leukaemia of B- and T-cell subtype: a state-of-the-art paper. Eur J Haematol. 2008;80:469–76.
Schlette E, Bueso-Ramos C, Giles F, Glassman A, Hayes K, Medeiros LJ. Mature B-cell leukemias with more than 55% prolymphocytes. A heterogeneous group that includes an unusual variant of mantle cell lymphoma. Am J Clin Pathol. 2001;115:571–81.
Lens D, De Schouwer PJ, Hamoudi RA, Abdul-Rauf M, Farahat N, Matutes E, et al. p53 abnormalities in B-cell prolymphocytic leukemia. Blood. 1997;89:2015–23.
Robak T, Robak P. Current treatment options in prolymphocytic leukemia. Med Sci Monit. 2007;13:RA69–80.
Leoni LM, Bailey B, Reifert J, Bendall HH, Zeller RW, Corbeil J, et al. Bendamustine (Treanda) displays a distinct pattern of cytotoxicity and unique mechanistic features compared with other alkylating agents. Clin Cancer Res. 2008;14:309–17.
Knauf WU, Lissichkov T, Aldaoud A, Liberati A, Loscertales J, Herbrecht R, et al. Phase III randomized study of bendamustine compared with chlorambucil in previously untreated patients with chronic lymphocytic leukemia. J Clin Oncol. 2009;27:4378–84.
Roué G, López-Guerra M, Milpied P, Pérez-Galán P, Villamor N, Montserrat E, et al. Bendamustine is effective in p53-deficient B-cell neoplasms and requires oxidative stress and caspase-independent signaling. Clin Cancer Res. 2008;14:6907–15.
Stilgenbauer S, Zenz T. Understanding and managing ultra high-risk chronic lymphocytic leukemia. Hematology Am Soc Hematol Educ Program. 2010;2010:481–8.
Treanda [package insert]. Frazer: Cephalon, Inc.; 2008.
Ramdial PK, Naidoo DK. Drug-induced cutaneous pathology. J Clin Pathol. 2009;62:493–504.
Ardern-Jones MR, Friedmann PS. Skin manifestations of drug allergy. Br J Clin Pharmacol. 2011;71:672–83.
Alamdari HS, Pinter-Brown L, Cassarino DS, Chiu MW. Severe cutaneous interface drug eruption associated with bendamustine. Dermatol Online J. 2010;16:1.
Gerson D, Sriganeshan V, Alexis JB. Cutaneous drug eruptions: a 5-year experience. J Am Acad Dermatol. 2008;59:995–9.
Ghersetich I, Comacchi C, Jorizzo JL, Katsambas A, Lotti TM. Proposal for a working classification of cutaneous vasculitis. Clin Dermatol. 1999;17:499–503.
Hautmann G, Campanile G, Lotti TM. The many faces of cutaneous vasculitis. Clin Dermatol. 1999;17:515–31.
Walsh SA, Creamer D. Drug reaction with eosinophilia and systemic symptoms (DRESS): a clinical update and review of current thinking. Clin Exp Dermatol. 2011;36:6–11.
PubMed CrossRef Copyright information
© The Japanese Society of Hematology 2012