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Article Review/Hyperlink
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Talar-Williams C, Hijazi Y, Walther MM, Linehan WM, Hallahan
CV, Lubensky I, et al.
Cyclophosphamide-induced cystitis and bladder cancer in
patients with Wegener granulomatosis
Ann Intern Med
(Mar) 124:477-484 1996

This study describes the incidence and clinical manifestations of bladder
toxicity
occurring in 145 patients who received cyclophosphamide for the treatment of
Wegener's
granulomatosis. More than half experienced nonglomerular hematuria.
Seventy
percent of those with hematuria who had cystoscopy were found to have
cyclophosphamide-induced bladder injury. Seven patients developed
a transitional-cell carcinoma of the bladder. Six of the seven patients had
a
total cumulative
cyclophosphamide dose exceeding 100 g with a cumulative duration greater
than
2.7
years. All of the patients with bladder cancer had microscopic or gross
hematuria.
None of the patients without hematuria developed bladder cancer. The
estimated
incidence of bladder cancer after the first exposure to cyclophosphamide was
5% at 10 years and 16% at 15 years.
Comment: Cyclophosphamide is effective for the treatment of Wegener's
granulomatosis.
Its metabolite, acrolein, is excreted in the urine and is associated with
substantial urinary
tract toxicity. Although hemorrhagic cystitis is a well-characterized
complication or oral cyclophosphamide therapy, this important study defines
the
incidence of
cyclophosphamide-induced cystitis and its relation to transitional-cell
carcinoma. This investigation identifies a subgroup of patients at high risk
for
the development of
bladder cancer. (George R. Aronoff, M.D., FACP, University of
Louisville)
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