RESEARCH - Hematologic malignancy linked to cyclophosphamide for RA

March 15, 2008

Hematologic Malignancy Linked to Cyclophosphamide for Rheumatoid Arthritis

By Will Bogs, MD

NEW YORK (Reuters Health) Mar 06 - Cyclophosphamide treatment of

rheumatoid arthritis (RA) is associated with an increased risk of

hematologic malignancy, according to a report from Canada in the

February 25th issue of the Archives of Internal Medicine.

" Some drugs (specifically, cyclophosphamide) do play a role in some of

the hematologic malignancies that arise in autoimmune diseases like RA

and lupus, " Dr. Sasha Bernatsky told Reuters Health. " However, some

drugs, like methotrexate, don't seem to be associated with a great

risk of these cancers. "

Dr. Bernatsky from McGill University Health Centre in Montreal,

Quebec, and colleagues assessed the risk in RA of hematologic

malignancy associated with exposure to disease-modifying antirheumatic

drugs (DMARDs). They used database information on 23,810 patients with

rheumatoid arthritis treated with DMARDS from 1980 through 2003.

During that time, 619 patients developed hematologic malignancies.

After adjustments for other DMARD use and other factors, only

cyclophosphamide was associated with a significantly increased risk

for hematologic malignancy, with a relative risk of 1.84, the authors

report.

Methotrexate, azathioprine, antimalarial agents, and anti-TNF agents

were not associated with a significantly increased risk in the

adjusted analysis, the researchers note.

Lymphoma, leukemia, and multiple myeloma were the most frequently

noted specific types of hematologic malignancies.

" Obviously, a drug like cyclophosphamide, with severe potential

adverse effects, should be used only when necessary, " Dr. Bernatsky

said. " However, at the present time cyclophosphamide remains an

important option for very severe autoimmune disease manifestations

(e.g., severe vasculitis or lupus nephritis). "

Arch Intern Med 2008;168:378-381.

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Not an MD

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