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Acute leukaemia after immunosuppressive therapy.

M M Roberts

    Lancet (London, England)
    |October 9, 1976
    PubMed
    Summary

    Cyclophosphamide treatment for renal disease was linked to acute myeloid leukemia in three patients. This immunosuppressive drug may increase cancer risk by allowing malignant cells to grow or by enabling viruses to trigger cancer development.

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    Area of Science:

    • Oncology
    • Immunology
    • Nephrology

    Background:

    • Cyclophosphamide is an alkylating agent used in treating various conditions, including renal diseases.
    • The immunosuppressive properties of cyclophosphamide are well-documented.
    • Secondary malignancies following immunosuppressive therapy are a recognized concern.

    Observation:

    • Three cases of acute myeloid leukemia (AML) were observed in patients treated for renal disease with cyclophosphamide.
    • These cases did not involve concurrent irradiation, other cytotoxic agents, or pre-existing malignancies.
    • Marrow aplasia was excluded as a direct cause of the observed leukemia.

    Findings:

    • The development of AML post-cyclophosphamide treatment suggests a potential causal link.
    • The study proposes two mechanisms for cyclophosphamide-induced oncogenesis: emergence of malignant clones or viral oncogenesis due to impaired immune surveillance.

    Implications:

    • Cyclophosphamide's immunosuppressive effects may increase the risk of secondary malignancies like AML.
    • Further research is warranted to elucidate the precise mechanisms and quantify the risk.
    • This finding has implications for risk-benefit assessments in patients undergoing cyclophosphamide therapy for renal and other conditions.

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