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Table 4 Strategy to reduce risk of systemic immunosuppressive therapy related malignancies

From: Are patients with inflammatory eye disease treated with systemic immunosuppressive therapy at increased risk of malignancy?

 

Strategy

Pre-treatment

Careful pre-treatment evaluation of patients for presence of immunodeficiency (e.g. HIV), past or family history of malignancy and pre-malignant conditions (e.g. Bowen's disease, CIN of cervix, GIT polyps, leukoplakia of lip)

Dosages and therapy

Minimise dose and duration of immunosuppressive therapy (e.g. use of alkylating agents, such as cyclophosphamide for <12 months) - consider drugs with less oncogenic potential (e.g. MTX, mTOR inhibitors (sirolimus))

Education

Patient education - stop smoking, avoid excessive exposure to UV radiation, immunisation against HPV, regular self-examination (e.g. skin, lips, breast)

Follow-up

Regular and annual review - screening for common immunosuppressive therapy associated malignancies (e.g. skin, cervix, bladder, lymph nodes)