Bladder malignancy in a patient receiving low dose cyclophosphamide for treatment of rheumatoid arthritis

✍ Scribed by Alan F. Ansher; John W. Melton III; Anthony J. Sliwinski

• Publisher: John Wiley and Sons
• Year: 1983
• Tongue: English
• Weight: 204 KB
• Volume: 26
• Category: Article
• ISSN: 0004-3591
• DOI: 10.1002/art.1780260618

✦ Synopsis

Cyclophosphamide treatment of malignant disease has been strongly associated with an increased incidence of bladder cancer. Recently there have been 3 papers reporting 4 cases of bladder cancer in patients treated with cyclophosphamide for benign disease (1-3). However, there is no increased incidence of bladder cancer in rheumatoid arthritis (RA) patients who were not treated with immunosuppressives (43). In most of the cyclophosphamide-associated bladder cancer cases, the dose of cyclophosphamide was 100 mg/day or higher. There has been an increase recently in the use of long-term low-dose (less than 75 mg/day) cyclophosphamide in the treatment of RA, in an attempt to avoid the side effects commonly seen with high-dose therapy. Marshall and Klinefelter showed that hemorrhagic cystitis can develop after long-term low-dose cyclophosphamide therapy for RA (1). Our case is the first report of bladder cancer developing in a patient who received a maximum of 50 mg/day cyclophosphamide for treatment of nonmalignant disease. Case report. The patient is a 75-year-old white woman with a 24-year history of RA. Her disease

From the Division of Rheumatic Diseases