Letter: Lymphoma and anticonvulsive therapy

Myelomatosis after Phenytoin Therapy A Chance Association?

“…Cases of angioimmunoblastic lymphadenopathy have recently been reported in patients receiving Dilantins (Frizzera et a1 1975, Moore et a1 1976 and prolonged follow-up in these patients has revealed that some eventually developed true malignant lymphoma (Am J Med 1962, Gams et a1 1968). Furthermore, Hodgkin's lymphoma has been reported to occur in patients receiving phenytoin for many years, without prior development of 'pseudolymphoma' (Hyman & Sommers 1966, Fraumeni & Li 1969, Antony 1970, Charlton & Lunsford 1971, Rausing & Treli 1971, Grundy et a1 1973, Tashima & De Los Santos 1974, Li et a1 1975, and the drug has been implicated in the etiology of lymphoma in man. While some of the above authors have reported a two-four fold increase in incidence in lymphoma in these patients, others (Clemmesen et a1 1974) found no excess risk of any form of cancer in epileptic patients receiving anticonvulsants.…”

“…Phenytoin has been shown to suppress both cellular and humoral immune responses (Sorrell et a1 1971, Grob & Herold 1972, Sorrell & Forbes 1975 and cause hypersensitivity reactions with the development of lymphadenopathy ('pseudolymphoma') (Saltzstein & Ackerman 1959, Choovivathanavanich et a1 1970, Dorfman & Warnke 1974 and angioimmunoblastic lymphadenopathy (Frizzerra et a1 1975, Lukes & Tindle 1975, Moore et a1 1976. Several clinical reports have also implicated phenytoin in the eitology of Hodgkin and non-Hodgkin lymphoma (Hyman & Sommers 1966, Gams et a1 1968, Antony 1970, Tashima & De Los Santos 1974, Li et a1 1975. The occurrence of monoclonal gammopathy and multiple myeloma during chronic anticonvulsant therapy is extremely rare and to the best of our knowledge has been documented only in a single instance (CPC, Am J Med 1962).…”