Combination Chemotherapy

Recently, our unit has observed 6 patients with haema-tological malignancy (5 had a lymphoma and 1 had acute myeloid leukaemia) who developed an autoimmune connective tissue disease following combination chemotherapy [24], Three patients developed SLE and 1 each developed lupus profundus, limited cutaneous systemic sclerosis and Churg-Strauss syndrome. Only 1 of these patients received interferon-a and his SLE developed 5 years after this therapy. These connective tissue diseases manifested themselves between 1 and 63 months after the first chemotherapy course and all cases responded to modest doses of prednisolone and/or hydroxychloroquine, though the patient with Churg-Strauss syndrome received prednisolone and azathioprine. Three of the 6 patients have subsequently died from recurrent malignancy.

There are many possible reasons for the development of autoimmune disease following chemotherapy, not least of which is the remote possibility that the lymphoma was a disease manifestation that preceded the appearance of the CTD. The coincidental appearance of the two conditions also cannot be excluded. However, there are more cogent possible explanations. In recent years there has been a change in chemotherapy regimens for malignancies with ever more toxic combinations in the search for effective remission inducing regimens. Taken together, the description of 46

patients with postchemotherapy rheumatism and the development of defined CTD following chemotherapy for lymphoma or leukaemia suggests that combination chemotherapy may capable of disturbing the immune system profoundly enough to alter the normal balance of self-tolerance, possibly by altering thymic function, leading to autoimmunity.

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