Background Treatment of rheumatological pts by alkylating cytostatics is undoubtedly of positive effect on the process of the disease but in a long term can stimulate the development of neoplasms and lymphatic proliferative diseases.
Objectives To detalise the degree of risk of above mentioned pathologies in SS pts who for a long time took low doses of chlorobutin or cyclophosphane – from 5 to 15 years.
Methods In the 1st group of 300 pts aged 15–75 years (46.4(1.7) with disease duration of 5–25 years (8.7(1.9) 200 pts took 5 mg of Prednisolone daily, 1.8 g for a year, 0.9–1.8 g for the subsequent years combined with chlorobutin by 2 mg daily; 720 mg for a year and 360–720 mg for the next years. 100 pts had cyclophosphane by 200 mg twice a month i.v.; 4.8 g for a year and in the next 5 years yearly dosage was 2.4–4.8 g. 2nd group included 100 female pts who took only Prednisolone according the same scheme. 3d group of 100 female pts had no antirheumatic therapy. Age of pts in 2nd and 3d groups was 18–78 years (46.2(2.3) and disease duration of 4–26 years (9.2(2.1). Minimal frequency of blastomas and lymphatic proliferative diseases (1.6%) development was in the 1st group (pseudolymphoma in 1 pt, lymphoma – 2 cases, cancer of stomach in 1 and of skin in 1 pt). In the group treated only by GCS 7 cases of lymphoma were found and 1 case of stomach cancer (8%). Pts who had no antirheumatic therapy had 7 pseudolymphomas 9 lymphomas, 2 cases of Valdenstrem crioglobulinemia, 2 cases of stomach cancer and 1 pulmonary cancer (21%). Out of them pseudolymphomas and lymphomas were diagnosed in 18%.
Conclusion Long term of taking of low doses of cytistatics (chlorobutin, cyclophosphane) combined with low doses of GCS does not promote the development of blastoma process in SS pts and decreases the frequency of transformation of the disease in malignant lymphomas.
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