Chronic lymphocytic leukaemia, synchronous small cell carcinoma and squamous neoplasia of the urinary bladder in a paraplegic man following long-term phenoxybenzamine therapy

• Published in: Spinal cord 2006-03, Vol.44 (3), p.188-191
• Main Authors: Vaidyanathan, S, Mansour, P, Soni, B M, Hughes, P L, Singh, G
• Format: Article
• Language: English
• Subjects: Adult; Anatomy; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Carcinogens; Carcinoma; Carcinoma, Small Cell - chemically induced; Carcinoma, Small Cell - pathology; case-report; Catheters; CD56 Antigen - metabolism; Cerebrospinal fluid. Meninges. Spinal cord; Chlorambucil; Chronic lymphatic leukemia; Development. Senescence. Regeneration. Transplantation; Dislocation; Dysplasia; fludarabine; Fractures; Fundamental and applied biological sciences. Psychology; Hospitals; Human Physiology; Humans; Immunohistochemistry - methods; Injuries of the nervous system and the skull. Diseases due to physical agents; Internet; Leukemia, Lymphocytic, Chronic, B-Cell - chemically induced; Leukemia, Lymphocytic, Chronic, B-Cell - metabolism; Leukemia, Lymphocytic, Chronic, B-Cell - pathology; Leukocyte Common Antigens - metabolism; Magnetic Resonance Imaging - methods; Male; Medical sciences; Neoplasia; Neoplasms, Squamous Cell - chemically induced; Neoplasms, Squamous Cell - pathology; Nervous system (semeiology, syndromes); Neurochemistry; Neurology; Neuropsychology; Neurosciences; Paralysis; Paraplegia; Paraplegia - drug therapy; Paraplegia - rehabilitation; Penis; phenoxybenzamine; Phenoxybenzamine - adverse effects; Sheaths; Spinal cord injury; Time; Traumas. Diseases due to physical agents; Urinary bladder; Urinary Bladder Neoplasms - chemically induced; Urinary Bladder Neoplasms - pathology; Vasodilator Agents - adverse effects; Vertebrates: nervous system and sense organs
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/sj.sc.3101789

Study design: A case report. Objective: To raise awareness among spinal cord clinicians of the possible carcinogenic effect of phenoxybenzamine and of the rare occurrence of small cell carcinoma in the neuropathic bladder. Setting: Regional Spinal Injuries Centre and District General Hospital, Southport, Merseyside, United Kingdom. Case report: A 28-year-old man sustained a fracture dislocation of L-1 with consequent paraplegia (ASIA impairment scale A). Phenoxybenzamine treatment enabled his indwelling catheter to be discarded in favour of a penile sheath, but it caused unacceptable dizziness and was stopped after 7 years. After 20 years, he developed chronic lymphocytic leukaemia, which was treated with chlorambucil and fludarabine. After 2 years, investigation of bilateral hydronephrosis revealed a primary small cell carcinoma of the bladder with coexistent squamous dysplasia. Uraemia supervened and, declining active treatment, the patient died 3 weeks after diagnosis. Conclusion: Phenoxybenzamine, a known carcinogen in rodents, is likely also to be carcinogenic in humans, and patients with spinal cord injury who have received the drug for any significant period of time, need close follow-up to allow early detection of cancer. Phenoxybenzamine should not be prescribed on a long-term basis, and should instead be replaced with a selective alpha-blocker.