Multifocal central nervous system demyelination and Lhermitte's phenomenon secondary to combination chemotherapy for chronic lymphocytic leukaemia

J Neurol Sci. 2014 Mar 15;338(1-2):218-9. doi: 10.1016/j.jns.2013.12.032. Epub 2013 Dec 31.


The CRF regime (cyclophosphamide, rituximab and fludarabine) is used for the treatment of chronic lymphocytic leukaemia. We report a case of diffuse CNS demyelination following treatment with CRF, presenting with Lhermitte's phenomenon, and imaging and neurophysiological evidence of demyelination. Fludarabine is the most likely causative agent, although CNS demyelination has not been previously described in low dose therapy.

Keywords: Chemotherapy; Chronic lymphocytic leukaemia; Demyelination; Evoked response; Fludarabine; Lhermitte's sign.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Monoclonal, Murine-Derived / adverse effects
  • Cyclophosphamide / adverse effects
  • Hamartoma Syndrome, Multiple / chemically induced*
  • Hereditary Central Nervous System Demyelinating Diseases / drug therapy*
  • Humans
  • Immunologic Factors / adverse effects*
  • Leukemia, Lymphocytic, Chronic, B-Cell / chemically induced*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Rituximab
  • Vidarabine / adverse effects
  • Vidarabine / analogs & derivatives


  • Antibodies, Monoclonal, Murine-Derived
  • Immunologic Factors
  • Rituximab
  • Cyclophosphamide
  • Vidarabine
  • fludarabine