Carcinoma of the Urinary Bladder after Treatment with Cyclophosphamide for Non-Hodgkin's Lymphoma

Abstract

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.

Risk-based health monitoring of childhood cancer survivors: A report from the children’s oncology group

“…This complication is more common after pelvic radiation for childhood sarcoma (doses > 45 Gy) [33]. In addition, cyclophosphamide and radiation have been implicated in the development of bladder malignancies [34].…”

Immunosuppressive and cytotoxic pharmacotherapy for pulmonary disorders.

“…Hemorrhagic cystitis complicates CTX use in 5070 to 34% of patients and increases the risk of bladder fibrosis and carcinoma (11,56,62,63,(112)(113)(114)(115)(116)(117)(118). Acrolein, a cyclophosphamide metabolite, is considered to be the responsible toxin (56).…”

“…Transitional cell carcinoma develops in 2% to 15% of patients receiving long-term CTX (56,62,63,65,(112)(113)(114)(115)(116)(117). Antecedent hematuria is a common (62) but not uniform finding (65,117).…”

“…Antecedent hematuria is a common (62) but not uniform finding (65,117). The sentinel study affirming an increased risk of bladder carcinoma was published in 1988 (117).…”

“…Antecedent hematuria is a common (62) but not uniform finding (65,117). The sentinel study affirming an increased risk of bladder carcinoma was published in 1988 (117). Among 471 patients with nonHodgkin's lymphoma treated with CTX, seven bladder carcinomas were noted (a sevenfold risk above control subjects) (117).…”