Carcinoma of the urinary bladder after treatment with cyclophosphamide for non-Hodgkin's lymphoma.
We observed nine cases of transitional-cell carcinoma of the urinary bladder among patients who had had long-term treatment of other cancers with cyclophosphamide. Seven of the bladder carcinomas occurred within a cohort of 471 patients treated for non-Hodgkin's lymphomas. In this cohort the relative risk of bladder cancer was 6.8 (95 percent confidence interval, 3.2 to 14.2). The cumulative risk (mean +/- SE) was 3.5 +/- 1.8 percent 8 years after the start of treatment with cyclophosphamide and 10.7 +/- 4.9 percent after 12 years. Three of the nine patients were 50 years of age or younger; seven died with progressive bladder cancer. Subsequently, an additional patient had acute nonlymphocytic leukemia. Hemorrhagic cystitis was observed in 33 patients (cumulative risk, 11.8 +/- 2.1 percent after five years). Development of carcinoma of the urinary bladder was not related to previous hemorrhagic cystitis. The results caution against long-term treatment with cyclophosphamide for diseases with a favorable prognosis.
Pedersen-Bjergaard
J
J
Department of Internal Medicine and Hematology, Finsen Institute-Rigshospitalet, Copenhagen, Denmark.
Ersbøll
J
J
Hansen
V L
VL
Sørensen
B L
BL
Christoffersen
K
K
Hou-Jensen
K
K
Nissen
N I
NI
Knudsen
J B
JB
Hansen
M M
MM
D000328:Adult; D000367:Age Factors; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000139:chemically induced*; D003520:Cyclophosphamide / Q000009:adverse effects*; D003556:Cystitis / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D007938:Leukemia / Q000139:chemically induced; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced*
D003520:Cyclophosphamide