In the NEWS: Cancer risk after cyclophosphamide use in membranous GN

A common question has always been in our minds – cancer risk after cyclophosphamide use in renal diseases?

Membranous GN has been the landmark GN where cyclophosphamide has been tried. The regimen with alternating months of this agent with steroids is still the standard of care treatment for Membranous GN.  Other therapies have come and stayed or gone, such as CNIs, MMF and rituximab.  They have varied outcomes.

Cancer risk after use of cyclophosphamide recently waslooked at a single center in Europe in this CJASN manuscript.   Over 250 patients were followed over 6 years and 127 patients were treated with cyclophosphamide (CYP).  Cancer risk was 3 fold higher in this cohort compared to ones not treated with CYP. 

Interesting findings:

1.     As one would think, bladder ca would be the highest risk, it was only 2 of the 20 observed

2.     Hematologic malignancies were highest in this cohort

3.     Could some of their cases be secondary membranous and hence had cases of early malignancies?

4.     Table 3 has malignancies listed as Lung, CLL, lymphoma, prostate Ca, colon, AML, bladder and CML

5.     Majority were men

6.     Varied cancers ( 5) of them had membranous GN that was APLAR2 negative but no time correlations was noted

Full paper at http://cjasn.asnjournals.org/content/early/2014/05/22/CJN.08880813.full