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Cyclophosphamide Toxicity — SCE Rheumatology MCQ

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ModerateRheumatology PharmacologyCyclophosphamide ToxicitySCE Rheumatology

A 48-year-old woman on long-term Cyclophosphamide for lupus nephritis has received a cumulative dose of 30 g. She now wishes to switch to maintenance therapy. What important late complication of Cyclophosphamide should she be counselled about?

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Correct answer: D — Increased risk of bladder cancer and haematological malignancy

High cumulative doses of Cyclophosphamide are associated with an increased risk of bladder cancer (from acrolein metabolite exposure) and haematological malignancies, particularly myelodysplastic syndrome and acute leukaemia. Risk increases with cumulative dose (typically >36 g). MESNA and adequate hydration during IV infusions reduce but do not eliminate bladder toxicity. Premature ovarian failure is also an important consideration in women of reproductive age. Haematuria should be investigated promptly in any patient with prior Cyclophosphamide exposure.

Reference: EULAR 2023 - Recommendations for management of SLE; BSR lupus guidelines