General adverse response to cyclophosphamide in Chinese patients with systemic autoimmune diseases in recent decade — a single-center retrospective study

This study was conducted to investigate the adverse reaction to cyclophosphamide (CYC) in Chinese patients with systemic autoimmune diseases. Patients with systemic autoimmune diseases who were exposed to CYC and followed up regularly for at least 2 years in Rheumatology Department during June 2003 to June 2013 were enrolled into this study. Participants were divided into per oral (PO) group and intravenous (IV) group. The adverse effects to CYC were recorded and analyzed. A total of 419 patients were enrolled in this study. The occurrence rates of gastrointestinal discomfort, alopecia, myelosuppression, secondary infection, abnormal liver function, dizziness/headache, menstrual disturbance and reversal to normal menstruation after discontinuation of CYC were 21.5 %, 12.4 %, 7.4 %, 3.6 %, 3.1 %, 3.1 %, 30.3 % and 31.0 %, respectively. None of the patients had hemorrhagic cystitis. The significant risk factors for gastrointestinal discomfort were female, exposure to CYC for a long time and intravenous route. Risk factors for mylosuppression were female and combination with other immunosuppressants. Risk factors were female gender for alopecia and older age for menstrual disturbance. Female patients were much more likely to have gastrointestinal discomfort, mylosuppression and alopecia when CYC was administrated intravenously. Risk factors were older age for menstrual disturbance and the combination with other immunosuppressants for myelosuppression. Hemorrhagic cystitis did not appear in our series for the possible reason of prophylactic hydration before intravenous injection and maybe racial difference.