Potentially highly toxic - Must be experienced and specialist use and supervision only. Famously causes Haemorrhagic cystitis
- Akylating agent with significant marrow depression
- At the risk of infections and bleeding and a teratogen
Mode of action
- Prodrug activated by cytochrome p450 to 4 hydroxy-cyclophosphamide
- Effects are often delayed (up to 6 weeks in Rheumatological causes)
- Metabolites bind to DNA, thereby inhibiting DNA replication
- Malignant lymphomas (Stages III and IV of the Ann Arbor staging system), Hodgkin's disease, lymphocytic
lymphoma (nodular or diffuse), mixed-cell type lymphoma, histiocytic lymphoma, Burkitt's lymphoma.
- Leukemias: Chronic lymphocytic leukaemia, chronic granulocytic leukaemia (it is usually ineffective in acute blastic crisis), acute myelogenous and monocytic leukaemia, acute lymphoblastic (stem-cell) leukaemia in
children (CYTOXAN given during remission is effective in prolonging its duration).
- Multiple myeloma, Mycosis fungoides (advanced disease), Neuroblastoma (disseminated disease).
- Adenocarcinoma of the ovary, Retinoblastoma, Carcinoma of the breast
- Severe, refractory rheumatoid arthritis
- Severe complications of lupus, myositis, scleroderma, or vasculitis.
- Severe Autoimmune diseases
- Vasculitis, SLE, steroid-resistant nephrotic syndrome, progressive IgA-nephropathy
Dose - Check specialist literature: needs expert assessment
- Cyclophosphamide is often used for 3-6 months to treat a condition and put it into remission
- RA with severe systemic manifestations: Cyclophosphamide 1-1.5 mg/kg/day PO for specific duration depending on indication
- RA with severe systemic manifestations: Cyclophosphamide 0.5-1 g every 2 weeks then 0.5-1 g monthly
- leukaemias, lymphomas, and solid tumours: see local protocols
- Avoid live vaccines such as yellow fever
- Possible or Proven Pregnancy, Breastfeeding
- Nausea, Vomiting, Myelosuppression and later produces AML
- Lung fibrosis and Cardiac toxicity in high doses
- Haemorrhagic cystitis: prevent by good hydration and drinking 2-3 L /day and treatment with MESNA
- Long term risk of bladder carcinoma, lymphomas and tumours of the skin, for the myelodysplastic syndrome and permanent infertility.
- Advise seeking help if any sore throat, fever, symptoms of infection
unexplained bruising or bleeding
- Reduced fertility, hair loss, mouth ulcers and irregular
- Seek medical support if you haven't had chickenpox and you come into contact with someone who has chickenpox or shingles or you develop chickenpox or shingles.