Cyclophosphamide-induced cancers in pemphigus patients –A report of three cases

Abstract

Introduction: Cyclophosphamide is an important steroid-sparing immunosuppressive drug that was found to be effective for the treatment of autoimmune bullous disorders such as pemphigus. However, cyclophosphamide (an alkylating drug) is a mutagenic drug and is associated with the risk of malignancies. Three cases of cancers developing due to cyclophosphamide use in pemphigus are presented. Case Report: A 50-year-old male patient of pemphigus vulgaris received over 50 g of cyclophosphamide over 3 years. He died of bladder cancer 9 years after stopping the treatment. A 57-year-old male patient, a known case of diabetes, received over 100 g of cyclophosphamide for over 4 years for pemphigus foliaceus diagnosed with bladder cancer 5 years after stopping treatment. A 50-year-old male received around 100 g of cyclophosphamide over 3 years for pemphigus foliaceus diagnosed with squamous cell carcinoma of oral mucosa 2 years after stopping treatment. Conclusion: Cyclophosphamide is a mutagenic drug and is associated with the risk of malignancy which can appear many years after stopping the treatment; hence, long-term follow-up is important.