Kahn M F, Arlet J, Bloch-Michel H, Caroit M, Chaouat Y, Renier J C
Nouv Presse Med. 1979 Apr 14;8(17):1393-7.
The authors undertook a retrospective study to determine the number of acute leukaemias developing amongst 2006 patients suffering from chronic inflammatory rheumatic conditions and connective tissue disorders, treated with cytotoxic agents. The follow-up period ranged from 1 to 13 years. Nineteen leukaemias were found, essentially granulocytic, with a latent period of 5.7 +/- 2, 8 years after the beginning of treatment. This incidence of almost 1% of leukaemias is probably less than the actual percentage since a number of patients were lost on follow up and since the period of observation is as yet too short. The majority of patients has been treated for more than one year. No cases were seen amongst patients treated for less than six months, or with less than 1g of chlorambucil or 50 g of cyclophosphamide. The risk would seem to be the same for both alkylating agents. No patients treated with azathioprine developed leukaemia, but few patients received this drug. Amongst 35 patients treated for severe psoriatic arthropathy with chlorambucil, 4 developed leukaemia. This particularly high percentage is such that all trials of alkylating agent in this condition should be stopped. The prevalence of leukaemia seen in the series as a whole is comparable to that found in mass studies carried out in various malignant diseases treated by cytotoxics. Awareness of this risk should, lead to even stricter limitations before the use of cytotoxic drugs in rheumatological conditions.
作者进行了一项回顾性研究，以确定在2006例患有慢性炎症性风湿性疾病和结缔组织疾病并接受细胞毒性药物治疗的患者中发生急性白血病的数量。随访期为1至13年。发现19例白血病，主要为粒细胞性，治疗开始后潜伏期为5.7±2.8年。白血病近1%的发病率可能低于实际百分比，因为一些患者在随访中失访，且观察期仍较短。大多数患者接受治疗超过一年。在治疗不到六个月或使用苯丁酸氮芥少于1g或环磷酰胺少于50g的患者中未发现病例。两种烷化剂的风险似乎相同。接受硫唑嘌呤治疗的患者中没有发生白血病，但接受该药物治疗的患者很少。在35例用苯丁酸氮芥治疗严重银屑病关节炎的患者中，有4例发生白血病。这一特别高的百分比使得在此情况下所有烷化剂试验都应停止。该系列中观察到的白血病患病率与在接受细胞毒性药物治疗的各种恶性疾病的大规模研究中发现的患病率相当。意识到这种风险应该导致在风湿性疾病中使用细胞毒性药物之前有更严格的限制。
