Chlorambucil is an alkylating agent widely used in the treatment of lymphoproliferative diseases.
General: fever, stomatitis, pharyngitis, conjunctivitis.
Cutaneous: toxic epidermal necrolysis, maculopapular erythema, urticaria.
Pulmonary: interstitial pneumonitis (14 cases up to 1994).
Hematological: immune hemolytic anemia (antibody able to bind complement to erythrocytes only in the presence of chlorambucil).
Patch-tests: chlorambucil mixed in vaseline 5% and 10% positive in 2 cases of toxic epidermal necrolysis.
Cutaneous biopsy (toxic epidermal necrolysis).
Re-challenge test is often positive but harmful.
Unproven, but type III allergic reaction is likely (immune complex deposition).
Cross-reactivity between alkylating agents is exceptional.