CyA in Systemic Lupus Erythematosus

Some evidence suggest that patient with systemic lupus erythematosus (SLE) have a higher incidence of malignancy, especially hematopoietic [63-65], breast, lung, and gynecological cancers [66,67] even if not all reports agree with this observation [68, 69]. None of the available lupus cohort studies have demonstrated a clear correlation between immunosuppression and higher cancer risk, but there is a reasonable concern of a possible increased risk with the additional exposure to immunosuppressive drugs. As a matter of fact, a high incidence of cervical atypia in women with SLE treated with cytotoxic drugs has been reported [70],

The use of CyA for the management of SLE has been spreading over the last few years. It has been proved successful in improving disease activity in patient with severe steroid-resistant or dependent SLE [71-74]. More recently Caccavo et al. [75] demonstrated a steroid-sparing effect of CyA combined with a good efficacy in reducing disease activity in 30 SLE patients; no malignancy are reported after 2 years of CyA therapy (2.5-5 mg/Kg/die). Our experience on 58 SLE patients receiving CyA orally as a single treatment or in association with steroids or various other drugs (hydroxiclorochine, methotrexate, azathioprine, cyclophosphamide, thalidomide and intravenous immunoglobulins) for an average of 26 months at the initial dosage of 5 mg/kg/day and progressively reduced to 3 mg/kg/day according to the individual clinical responses, has produced similar results: no cancer developed during treatment and after more than three years of follow-up (unpublished data).

However, as cancers with a possible virus-related etiology, such as cervical and vaginal ones, are very often observed in SLE patients [70, 76], it is advisable that females who receive CyA should have cervical smears taken at regular interval; in particular it could be useful the extensive search for human papilloma virus. Similarly, due to an increased incidence of breast cancers in women with SLE [66], careful manual and instrumental examination is suggested periodically in those taking immunosuppressive therapy.

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