Bone marrow depression cyclophosphamide

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. 

The risk of bone marrow depression by cytostatic drugs is potentiated by allopurinol, which also appears to potentiate the therapeutic effect of purine cytostatic drugs, since it competitively inhibits their metabolic breakdown. Studies in animals suggest that this reaction occurs only with oral mercaptopurine (28), although there is older evidence that the toxicity of cyclophosphamide and other cytostatic drugs can be increased by allopurinol (SED-9, 156). The danger of combining allopurinol with azathioprine has been confirmed by cases of bone marrow suppression, particularly in patients with impaired renal function (SEDA-16,114). 

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 bone marrow depressant effects of aclarubicin can be particularly severe in patients who have previously been treated with nitrosoureas or mitomycin. Aclarubicin appears not to interact with cyclophosphamide, cytarabine, enocitabine (behenoyl cy-tarabine), fluorouracil, mercaptopurine, tioguanine or vincristine. 

There is some evidence to surest that the incidence of serious bone marrow depression caused by cyclophosphamide can be increased by allopurinol, but this was not confirmed in a controlled study. Allopurinol may prolong the half-life of cyclophosphamide and increase the levels of its cytotoxic metabolites. 

In one preliminary report, the addition of vinblastine to zidovudine resulted in severe bone marrow depression. Similarly, 9 of 21 patients could not tolerate zidovudine while receiving a chemotherapy regimen (cyclophosphamide, doxorubicin, teniposide, prednisone, vincristine and bleomycin) because of haematological toxicity. ... 

Cytotoxic agents destroy immimologically competent cells. Azathioprine, a prodrug for the purine antagonist mercaptopurine, is used in autoimmune disease because it provides enhanced immunosuppressive activity. Cyclophosphamide is a second choice. Bone marrow is depressed as is to be expected. 

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