Prolonged risk of specific malignancies following cyclophosphamide therapy among patients with granulomatosis with polyangiitis
Research output: Contribution to journal › Journal article › Research › peer-review
OBJECTIVE: The long-term cancer risk for patients treated for granulomatosis with polyangiitis (GPA) is not well characterized. We assessed the risk of early and late-occurring cancers among 293 patients diagnosed with GPA from 1973 to 1999 and followed throughout 2010.
METHODS: Cancer incidence in the cohort was determined by linkage with the Danish Cancer Registry and compared with that in the general population by calculation of standardized incidence ratios (SIRs).
RESULTS: The median duration of follow-up was 9.7 years (range 0-36). Seventy-three cancers occurred, of which 30 were non-melanoma skin cancers (NMSCs) and 11 were bladder carcinomas. A high occurrence of NMSC was observed from the second year of follow-up onwards, with a SIR of 7.0 (95% CI 2.3, 16) for cases diagnosed ≥20 years after GPA. The incidence of bladder cancer increased after 5-9, 10-14 and 15-19 years of follow-up, with SIR estimates for these latency periods of 5.3 (95% CI 1.1, 15), 14.4 (95% CI 5.3, 31) and 10.5 (95% CI 1.2, 38), respectively. The incidence of myeloid leukaemia was significantly increased during years 5-9 [SIR 23.9 (95% CI 2.7, 86)]. Increased incidence of NMSC, bladder cancer and myeloid leukaemia was observed among patients exposed to cumulative CYC doses >36 g, while the only malignancy type observed in excess among those treated with lower CYC doses was NMSC. The cancer risk among CYC-naive patients was not significantly increased.
CONCLUSION: GPA patients experience a greater than expected number of specific malignancies following conventional therapies. Our analyses demonstrate a substantially increased risk of very late-occurring NMSC and bladder cancer in this patient group.
Original language | English |
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Journal | Rheumatology (Oxford, England) |
Volume | 54 |
Issue number | 8 |
Pages (from-to) | 1345-1350 |
Number of pages | 6 |
ISSN | 1462-0324 |
DOIs | |
Publication status | Published - Aug 2015 |
- Adolescent, Adult, Aged, Aged, 80 and over, Antirheumatic Agents, Cohort Studies, Cyclophosphamide, Denmark, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Granulomatosis with Polyangiitis, Humans, Incidence, Male, Middle Aged, Registries, Retrospective Studies, Risk Factors, Skin Neoplasms, Treatment Outcome, Urinary Bladder Neoplasms, Young Adult
Research areas
ID: 152272085