Myelotoxicity of Cyclophosphamide, Methotrexate and 5-fluorouracil Regimen in the Early Stage Breast Cancer Patients with Diabetes Mellitus

CMF (cyclophosphamide, methotrexate and 5-fluorouracil) is one of the most commonly used chemotherapy (CT) regimens in breast cancer. To the best of our knowledge there are no published studies on the toxicity of this regimen in the existence of diabetes mellitus (DM), in the literature. We retrospectively analyzed the myelotoxicity of CMF CT after 40 adjuvant cycles of 18 diabetics, according to WHO toxicity scala. Leucopenia/
granulocytopenia was the most prominent toxicity (observed in overall 30% of the cycles), but it was relatively mild (5% grade III and 2.5% grade IV granulocytopenia). Anemia was only grade I (10% of the cycles), and there was no trombocytopenia. Two of the cases with grade III and IV granulocytopenia, had grade I and II urinary tract infections respectively, following the CT. The case with grade IV granulocytopenia and infection had received G-CSF. We conclude that CMF regimen is tolerable in DM as regard to its myelotoxicity. However, the patients should be closely monitored as infections may easily arise in parallel to deepening leucopenia in DM. Further extended studies would be appropriate on the toxicity of CMF as well as the other common CT regimens in DM.