mercaptopurine and Kidney-Neoplasms

Although cytotoxic immunosuppressive agents play an unquestionably useful role in treating many neoplastic and non-neoplastic disorders, there is accumulating evidence that the toxicity associated with their use is considerable. The therapeutic successes obtained with antitumor agents have led to increases in the life span of cancer patients, but have also provided the opportunity for this toxicity to become manifest. A search of the available literature was carried out, with emphasis on cases in which a malignancy developed in patients following chemotherapy for either neoplastic or non-neoplastic (e.g., renal transplantation, psoriasis) conditions; particular focus was given to the incidence of acute myelogenous leukemia in various groups of Hodgkin's disease and multiple myeloma patients. That patients with nonmalignant conditions treated with cytotoxic immunosuppressive agents are also at increased risk of developing a malignancy raises the possibility that these agents may have oncogenic potential. Therefore, one may be faced with the paradox that the patients benefiting most from chemotherapy may be at highest risk of suffering its consequences.

Topics: Alkylating Agents; Animals; Antineoplastic Agents; Azathioprine; Burkitt Lymphoma; Choriocarcinoma; Cyclophosphamide; Dactinomycin; Female; Hodgkin Disease; Humans; Immunosuppressive Agents; Kidney Neoplasms; Leukemia, Myeloid, Acute; Lymphoma; Mechlorethamine; Melphalan; Mercaptopurine; Methotrexate; Mice; Multiple Myeloma; Neoplasms; Prednisone; Pregnancy; Procarbazine; Time Factors; Vincristine

We present a case of a 30-month-old child who presented with anemia and acute renal failure, and was found to have bilateral renal involvement by primary cytotoxic T-cell lymphoma. This was characterized by a monotonous interstitial lymphoid infiltrate with extensive necrosis. The tumor cells showed a CD8, granzyme, and TIA1-positive phenotype with no evidence of Epstein-Barr virus by in situ hybridization. The differential diagnosis based on the biopsy findings included a reactive interstitial nephritis; however, molecular studies confirmed T-cell clonality. She was started on induction chemotherapy and subsequently received maintenance therapy with methotrexate and 6-mercaptopurine. The patient had a complete response after chemotherapy and at 21 months of follow-up, she has no evidence of residual lymphoma; however, she has developed a dilated cardiomyopathy and she remains in renal failure. We discuss the morphologic, immunophenotypic, and molecular features of our case and describe the clinical course of our patient. We review the literature on primary renal lymphoma with an emphasis on T-lineage lymphomas and those that occur in children.

Topics: Acute Kidney Injury; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Cardiomyopathy, Dilated; Child, Preschool; Clone Cells; Female; Humans; Kidney Neoplasms; Lymphoma, T-Cell, Peripheral; Mercaptopurine; Methotrexate; Remission Induction; T-Lymphocytes, Cytotoxic

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Renal Cell; Colonic Neoplasms; Colonic Polyps; Cytarabine; Daunorubicin; Doxorubicin; Female; Humans; Idarubicin; Indoles; Kidney Neoplasms; Leukemia, Promyelocytic, Acute; Lung Neoplasms; Male; Mercaptopurine; Methotrexate; Middle Aged; Neoplasms, Second Primary; Pyrroles; Remission Induction; Sunitinib; Time Factors; Tretinoin

A case of acute non-lymphocytic leukemia who relapsed 7 years after the first remission is reported. The leukemic cells at onset had mature monocytic features with positive reactions for anti-CD14 antibody and alpha-NBE staining. By contrast, leukemic cells at relapse showed distinct morphological features from those at onset and lost their monocytic characters. No karyotypic abnormalities were found, but we could not exclude the possibility of secondary leukemia induced by the initial anti-leukemic chemotherapy.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Humans; Kidney Neoplasms; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Neoplasms, Second Primary; Prednisolone

Topics: Acute Disease; Asparaginase; Child; Child, Preschool; Cyclophosphamide; Dactinomycin; Female; Humans; Kidney Neoplasms; Leukemia, Lymphoid; Lung Neoplasms; Mercaptopurine; Methotrexate; Neoplasm Metastasis; Prednisone; Vincristine; Wilms Tumor

Topics: Abdominal Neoplasms; Adult; Aged; Antineoplastic Agents; Breast Neoplasms; Cyclophosphamide; Doxorubicin; Drug Therapy, Combination; Female; Fluorouracil; Gallbladder Neoplasms; Hodgkin Disease; Humans; Kidney Neoplasms; Liver Neoplasms; Lymphoma, Large B-Cell, Diffuse; Male; Mercaptopurine; Middle Aged; Pancreatic Neoplasms; Prednisolone; Rectal Neoplasms; Stomach Neoplasms; Ultrasonography; Vincristine

Topics: Adult; Brain Neoplasms; Chorionic Gonadotropin; Dactinomycin; Female; Humans; Hysterectomy; Kidney Neoplasms; Mercaptopurine; Methotrexate; Middle Aged; Pregnancy; Prognosis; Time Factors; Trophoblastic Neoplasms

Topics: Adenocarcinoma; Blood Cell Count; Carcinoma, Renal Cell; Epoetin Alfa; Erythropoietin; Geriatrics; Humans; Kidney Neoplasms; Lung Neoplasms; Mercaptopurine; Neoplasm Metastasis; Neoplasms; Neoplasms, Second Primary; Nephrectomy