PURPOSE: To demonstrate usefulness of chlorambucil in patients with severe sarcoidosis unresponsive to, or intolerant of, corticosteroids. 2) PATIENTS AND METHODS: Corticosteroid therapy was required in 192 (48%) of 401 patients with sarcoidosis seen at Thomas Jefferson University Hospital 1985-89. Chlorambucil was given to 31 of these patients because complicating diseases or problems made adequate corticosteroid dosage impossible (5 cases) or because of failure of corticosteroid in tolerable doses to control the disease (26 cases). 3) RESULTS: Marked improvement was observed in 15 cases, and moderate improvement in 13 others. Chlorambucil was well tolerated and complications attributable to immunosuppression did not occur. A six month course of chlorambucil was often followed by relapse, and prolonged therapy in reduced dosage appears necessary in most patients requiring this treatment. 4) CONCLUSION: Failure of corticosteroids in tolerable dosage to control sarcoidosis is not uncommon, and in such patients chlorambucil treatment is a useful alternative.
