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Altered mRNA expression of PAX5 is a common event in acute lymphoblastic leukaemia

transformation. Regarding late haematological toxicity, one of our eight patients developed bone marrow hypoplasia with pancytopenia 7 months after completion of 4 cycles of FCR, which was complicated by pneumonia. This was successfully treated with i.v. antibiotics, neutrophil counts recovered to normal with temporary G-CSF administration and the patient is now transfusionand growth factor-independent in ongoing CR (haemoglobin 110 g/l, white cell count 3Æ3 · 10/l, neutrophil count 1Æ73 · 10/l, platelet count 68 · 10/l now 10 months post-completion of four cycles of FCR). Delayed haematological toxicity associated with fludarabinebased chemotherapy is well-reported from chronic lymphocytic leukaemia trials (Tam et al, 2008). We have also observed delayed haematological recovery unrelated to persistent disease in 43% of patients with indolent lymphoproliferative diseases treated with fludarabine combinations (Gill et al, 2009). Also, the combination of fludarabine with alkylators results in a modest risk of development of myelodysplasia that may be higher than with fludarabine alone (Tam et al, 2006). Therefore, patients require careful follow-up after completion of therapy and prompt investigation and treatment with appropriate antimicrobials for febrile episodes. Thorough monitoring provided, in our experience this potential complication is manageable in the majority of cases and should not preclude patients with MZL being considered for treatment with one of the most effective therapies for their disease.