The Cancerogenicity Of Cya Experience From Other Immunemediated Diseases

Being effective in the modulation and prevention of experimental autoimmune uveitis [87], the use of CyA

for the treatment of human uveitis has been spreading over the last decade. Guidelines for an optimal use of CyA in noninfectious endogenous uveitis are available [88] where a maximal dose of 5 mg/Kg/die is suggested. In the same report, among the side effects described in 339 patients with endogenous intermediate and posterior uveitis in 15 different clinical studies, no malignancies are reported. It has been described a patient with Behcet's disease who developed fatal high grade lymphoma within 5 month of commencing CyA.

CyA has been proposed as a rapid acting alternative or adjunct to other drugs for refractory inflammatory bowel diseases (IBD). Only a high, and potentially more toxic, dosage seems to be effective for severe ulcerative colitis (UC) and fistulous Crohn's disease, therefore CyA may be used as a rescue therapy for short intervals [3]. It is well known that UC bears an intrinsic risk of colonic cancer which would makes the use of an immunosuppressant like CyA for long periods rather worrisome, but as far as we know, no malignancy due to CyA has been reported in patients with IBD, in particular no colonic cancer has been observed either during or after treatment [89, 90],

Among 661 patients (263 under 15 years of age) with idiopathic nephrotic syndrome exposed to CyA (5-6 mg/kg/die) for 435 patient-years, 5 malignancy developed: 2 Hodgkin's lymphoma (HL), 1 renal, 1 uterus adenocarcinoma and 1 bronchus squamous cell carcinoma in a smoker. These malignancies might have been related to CyA induced immunosuppression as well as nephrotic syndrome itself. Actually, the association between HL and nephrotic syndrome has been described [91].

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