[Successful combined treatment with rituximab and high dose immunoglobulin in a patient with chronic lymphocytic leukemia with fludarabine-induced severe immune thrombocytopenia].

Chronic lymphocytic leukemia is rarely associated with immune thrombocytopenia. Although fludarabine treatment is widely used in the treatment of chronic lymphocytic leukemia, it can also increase the incidence and severity of immune thrombocytopenia. The authors present a case of chronic lymphocytic leucaemia after relapse of the disease. Fludarabine + cyclophosphamide treatment was administered which resulted in a nearly complete hematological remission but severe immune thrombocytopenia has occurred (platelet count < 5 x 10(9)/l). Conventional steroid and immunosuppressive treatment have failed and, in addition, autoimmune hemolysis has developed after six weeks. Rituximab (375 mg/m2) and high dose intavenous immunglobuline treatment was started and platelet count has increased (40 x 10(9)/l). Prolonged (> 1.5 year) remission and subsided hemolysis have been observed due to the rituximab treatment. Successful treatment of choice can be rituximab in those cases of chronic lymphocytic leukemia which previously have been treated with fludarabine and associated with severe immune thrombocytopenia.