Alopecia cyclophosphamide

Toxicity Large doses of the drug (usually needed for immunosuppression) cause pancytopenia, gastrointestinal distress, hemorrhagic cystitis, and alopecia. Cyclophosphamide (and other alkylating agents) may cause sterility. 

Alkylating agents Cyclophosphamide Myelosuppression, hemorrhagic cystitis Alopecia, stomatitis, amenorrhea, aspermia, secondary leukemias... 

Most anticancer drugs damage hair follicles and produce partial or complete alopecia. Patients should be warned of this reaction, especially if paclitaxel, cyclophosphamide, doxorubicin, vincristine, methotrexate, or dactinomycin is used. Hair usually regrows normally after completion of chemotherapy. 

Bone marrow suppression that affects white blood cells more than platelets is the major dose-limiting toxicity. Maximal suppression of blood cell count occurs 10 to 14 days after drug administration recovery is generally seen 21 to 28 days after injection. Cyclophosphamide reduces the number of circulating lymphocytes and impairs the function of both humoral and cellular (i.e., B and T cell) aspects of the immune system. Chronic therapy increases the risk of infections. Nausea may occur a few hours after administration. Alopecia is more common than with other mustards. 

Ifosfamide is less myelosuppressive than cyclophosphamide but is more toxic to the bladder. It also may produce alopecia, nausea, vomiting, infertility, and second tumors, particularly acute leukemias. Neurological symptoms including confusion, somnolence, and hallucinations have also been reported. It is recommended... 

The major indications for melphalan are in the palliative therapy of multiple myeloma and cancers of the breast or ovary. Because it does not produce alopecia, melphalan is occasionally substituted for cyclophosphamide in the CMF regimen for breast cancer. 

Mechlorethamine Forms DNA cross-links, resulting in inhibition of DNA synthesis and function Hodgkin s and non-Hodgkin s lymphoma Nausea and vomiting Moderate depression of peripheral blood count excessive doses produce severe bone marrow depression with leukopenia, thrombocytopenia, and bleeding alopecia and hemorrhagic cystitis occasionally occur with cyclophosphamide cystitis can be prevented with adequate hydration busulfan is associated with skin pigmentation, pulmonary fibrosis, and adrenal... 

Cyclophosphamide (Cytoxan and Endoxan) is used in the treatment of Hodgkin s disease, lymphosarcoma, and other lymphomas. It is employed as a secondary drug in patients with acute leukemia and in combination with doxorubicin in women with breast cancer. A drug combination effective in the treatment of breast cancer is cyclophosphamide, methotrexate, fluorouracil, and prednisone (CMFP). Cyclophosphamide is also an immunosuppressive agent. The toxicity of cyclophosphamide causes alopecia, bone marrow depression, nausea and vomiting, and hemorrhagic cystitis. 

Cyclophosphamide causes significant dose-related infertility in both men and women as well as bone marrow suppression, alopecia, hemorrhagic cystitis, and, rarely, bladder carcinoma (see Chapter 55 Cancer Chemotherapy). 

Common adverse effects observed at low doses of cyclophosphamide are similar to, but less frequent than, those observed in oncology patients. They include gastrointestinal disturbances (mostly nausea), hematological toxicity (mostly leukopenia), alopecia, and infectious complications (4,5). 

Alopecia occurs in patients taking cyclophosphamide, but it is less common and less severe in patients taking low doses. Mild to moderate alopecia was observed in 17% of patients with Wegener s granulomatosis (4). 

Dactinomycin is used against ihabdomyasarcoma and Wilms tumor in children. It can be liicsaving for women with choriocarcinoma resistant to methotrexate. In combination with vincristine and cyclophosphamide, it has received some use in. solid tumors in children. Toxic reaction.s include anorexia, nausea, and vomiting. Bone marrow depression, resulting in pancytopenia, may occur within a week after therapy. Alopecia, erythema, and tissue injury may ixtcur at the injection site. 

The immunosuppressive effect of cytotoxic agents, with or without the concurrent use of steroids, can result in serious infections, which are the primary cause of death in patients with minimal-change nephropathy. Other toxicities associated with cyclophosphamide include gonadal fibrosis, which results in sterility, hemorrhagic cystitis, alopecia, and a potential to develop malignancy in those on long-term treatment. Patients on chronic steroid therapy often develop growth retardation, osteoporosis, obesity, and cataracts. ... 

Carboplatin and cyclophosphamide are indicated in the treatment of advanced ovarian carcinoma. Cisplatin and carboplatin produce predominantly interstrand DNA crosslinks rather than DNA-protein cross-links, and the effect is cell-cycle nonspecific. Carboplatin is not bound to plasma proteins, whereas platinum from carboplatin becomes bound to plasma protein and is eliminated slowly with a half-life of 5 days. The major route of elimination of carboplatin is the kidneys, and its doses should be reduced in renal impairment. Furthermore, the coadministration of aminoglycosides increases the chance of nephrotoxicity. Carboplatin causes anemia, neutropenia, leukopenia, and thrombocytopenia requiring transfusions. Cisplatin and, to a lesser extent, carboplatin cause emesis, which requires treatment with antiemetic agents. Alopecia, pain, and asthenia do occur (see also Figure 15). 

Cyclophosphamide causes immunosuppression and may cause secondary neoplasm especially when taken with radiation therapy. The side effects of cyclophosphamide are anorexia, nausea, vomiting, diarrhea, stomatitis, and alopecia. Leukopenia, interstitial pulmonary fibrosis, and hemorrhagic cardiac necrosis occur with large doses. 

Toxicity Gastrointestinal distress, myelosuppression, and alopecia are expected adverse effects. Hemorrhagic cystitis due to the formation of acrolein may be decreased by vigorous hydration and by use of mercaptoethanesulfonate (mesna). Cyclophosphamide may also cause cardiac dysfunction, pulmonary toxicity, and a syndrome of inappropriate ADH secretion. 

Cyclophosphamide Bone marrow suppression, hemorrhagic cystitis (consider mesna), alopecia, pulmonary infiltrates... 

Of particular significance to toxicology is that a chemical with a mechanism of action that requires interaction with an active metabohc process may only exert toxicity when hair growth is in an active growth phase. Exposure at other times may not elicit any response. Many cytotoxic chemicals (e.g., cancCT chemotherapeutic drugs and immunosuppressants such as cyclophosphamide) with a mechanism of action that is to kill dividing cells will produce hair loss (alopecia) as an imwanted side effect of nonselective activity. 

Kluger N, Jacot W, Frouin E, Rigau V, Poujol S, Dereure O, et al. Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel a prospective study of 20 patients. Ann Oncol 2012 23(ll) 2879-84. 

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