Cyclophosphamide: As Bad as Its Reputation? Long-Term Single Centre Experience of Cyclophosphamide Side Effects in the Treatment of Systemic Autoimmune Diseases

The study analyzed the short- and long-term side effects of cyclophosphamide (CYC) in 168 patients with systemic autoimmune diseases treated between 1984 and 2011. Gastro-intestinal side effects were the most common (68 events), followed by hair loss (38 events). Infections occurred in 26.2% of patients, with one infection-related death. Amenorrhoea was observed in 7.6% of females, with most cases being irreversible. Malignancies were noted in 19 patients after a median of 4.7 years, with older patients and those with higher cumulative CYC doses being more affected. Death occurred in 16.6% of patients, with two deaths likely related to CYC. The study concluded that while severe side effects were rare, long-term follow-up is essential for early detection of malignancies, and CYC's side effects do not necessarily warrant the use of newer drugs or biologic agents.