Page 1 of 1: cyclophosphamide toxicity

kitt · Credits: 180 My Scrapbook

I hope that u can solve this theoretical qn. If I have a lymphoma case which incidentally has lymphoid blasts in the circulation (peripheral smear). I am treating this case with cyclophosphamide. If I use a toxic dose of cyclophosphamide, I expect leukopenia/neutropenia due to bone marrow suppression. Should I in addition expect appearance of myeloid precursors in peripheral smear due to BM toxicity of cyclophosphamide. Pls. explain as to blast appearance in a patient taking cyclophosphamide.

wondergirl · Credits: 13247 My Scrapbook

no idea ..
can someone tell the right answer?

some info on cyclophosphamide----

Cyclophosphamide is a potent drug that is primarily used in the treatment of cancer. It belongs to the class of cytotoxic drugs called alkylating agents; these interfere with the growth and replication of malignant cells.

Cyclophosphamide is found to be useful in the treatment of some skin diseases, particularly autoimmune skin diseases or those associated with some sort of immune disorder. These include:

Wegener's granulomatosis
Dermatomyositis
Systemic lupus erythematosus
Behcet's disease
Cicatrical pemphigoid
Pemphigus vulgaris
Paraneoplastic pemphigus
Mycosis fungoides
Cyclophosphamide is available as 50mg tablets or in vials containing powder to be reconstituted for intravenous injection. The trade name in New Zealand is Cycloblastin™.

How to use cyclophosphamide
For the treatment of skin diseases, cyclophosphamide is usually used in combination with corticosteroids. Cyclophosphamide should only be used by a doctor experienced in its use, as the risk of toxicity is high and side effects potentially dangerous. It is essential that treatment with the drug is not more disabling then the disease it is being used to treat. Patients receiving cyclophosphamide require close supervision and monitoring throughout treatment.

Prior to starting treatment with cyclophosphamide a routine baseline assessment should include:

complete blood cell count
liver function tests
renal function tests.
Regular monitoring of these should continue throughout treatment.

Both oral and intravenous cyclophosphamide is used in treating skin disorders. Intravenous pulse administration of cyclophosphamide is often used in the treatment of pemphigus. This involves monthly administration of IV cyclophosphamide and is perceived to decrease the overall dosage and toxicity.

To prevent urinary toxicity such as haemorrhagic cystitis patients need to be adequately hydrated and pass urine frequently. Patients should be instructed to increase fluid intake 24 hours before, during and at least 24 hours after receiving cyclophosphamide and to pass urine frequently. Drinking 2 to 3 litres of water daily.

Contraindications
Cyclophosphamide should not be used under the following circumstances:

evidence of haemorrhagic cystitis, acute systemic or urinary infection, drug- or radiation-induced urothelial toxicity
severe bone marrow impairment
presence of infections (as a result of immunosuppression induced by cytotoxic treatment) which could lead to fatal complications.
Precautions
Pregnancy: women should not receive cyclophosphamide until pregnancy is excluded as it crosses the placenta and can cause fetal abnormalities. Cyclophosphamide should only be used in childbearing women if reliable contraceptive methods are being followed throughout treatment and for about 3 months after stopping the drug.

Breastfeeding: cyclophosphamide passes into breast-milk and may cause serious adverse reactions in the nursing infant. Breastfeeding is not recommended during cyclophosphamide therapy.

Side Effects
One of the major and dose-limiting side effects of cyclophosphamide is bone marrow toxicity. A fall in white blood cells is often seen 1-2 weeks after therapy but usually recovers within 3-4 weeks.

Other common side effects include:

nausea and vomiting
anorexia
abdominal discomfort or pain
diarrhoea
haemorrhagic cystitis (see precautions regarding increasing fluid intake)
hair loss usually occurs about 3 weeks after start of therapy
Drug Interactions
Cyclophosphamide is often used in combination with other cytotoxic drugs or immunosuppressant agents thus additive toxicity is likely to occur.

Other drugs that interact with cyclophosphamide to increase its toxicity include:

allopurinol
barbiturates
digoxin

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