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Malignancies after Tacrolimus therapy in the management of ocular inflammatory disease
Author(s) -
MATHEW MANU,
RAJ D,
MOHAMMED K,
ABEDIN A,
SULEMAN H,
DUA HS
Publication year - 2008
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2008.659.x
Subject(s) - medicine , tacrolimus , malignancy , gastroenterology , cancer , breast cancer , bladder cancer , scleritis , surgery , uveitis , transplantation , ophthalmology
Purpose The appearance of “de novo” tumors in adults receiving immunosuppressive treatment with tacrolimus in ocular inflammatory disorders has not been elucidated. Methods All 180 patients who received Tacrolimus as a steroid sparing agent for the management of high risk PKP, uveitis, scleritis or corneal stem cell allograft were studied. Tacrolimus treatment schedule, monitoring and duration of treatment was noted. Results During the last 8 years a total of 11 patients who had received Tacrolimus for their immunosuppresion developed a malignancy. Three patients developed cancer of prostate, bladder (1), bronchogenic carcinoma – squammous cell carcinoma (SCC) (1), cancer skin ‐ (SCC) (1), breast cancer(2), recurrence of NHL (1) and recurrence of breast cancer (1) and large intestinal tumour (1). The primary diagnosis for the commencement of Tacrolimus included high‐risk PKP (8), Scleritis (1), Panuveitis (1) and Wegeners Granulomatosis (1). The rate of increase of bladder cancer was 149.26 followed by NHL 82.33 and recurrent breast carcinoma 30.7. The rest of tumours had a rate of increase in the range of 10 ‐ 20 fold. The average dose of Tacrolimus was 1954.37 mg SD +/‐ 2197 mg. Female/male ratio was 2:1. The mean age of patients was 73 years SD +/‐ 10.4 years. The mean follow‐up time of tumour patients on treatment was 45 months with SD +/‐ 26 months and the mean duration of follow‐up after diagnosis was 23 SD +/‐ 19 months. None of the eleven patients had any additional predisposing factors or were on any other carcinogenic agents which could affect their mortality by the cancer identified. Conclusion Long term immunosuppressive management of patients requires regular oncologic screening.