Cyclophosphamide Colony-stimulating factors

Levesque JP, Hendy J, Takamatsu Y, Williams B, Winkler IG, Simmons PJ. Mobilization by either cyclophosphamide or granulocyte colony-stimulating factor transforms the bone marrow into a highly proteolytic environment. Exp Hematol 2002 30(5) 440-449. 

Egress of more mature cells from the bone marrow occurs through the endothelial cell barrier. Release of cells such as neutrophils may be stimulated by complement, steroids, or endotoxin. Immature (progenitor) cells that may ultimately become any one of the blood cellular components can be mobilized from the bone marrow into peripheral blood by the administration of a cytotoxic chemotherapy drug (e.g., cyclophosphamide) or a colony-stimulating factor (G-CSE or GM-CSE). This process is commonly referred to as priming the bone marrow for peripheral blood progenitor or stem cell transplantation (see Chap. 134). 

Wright D E, Cheshier S H, Wagers A J, et al. (2001). Cyclophosphamide/granulocyte colony-stimulating factor causes selective mobilization of bone marrow hematopoietic stem cells into the blood after M phase of the cell cycle. Blood. 97 2278-2285. Venezia T A, Merchant A A, Ramos C A, et al. (2004). Molecular signatures of proliferation and quiescence in hematopoietic stem cells. PLoS. Biol. 2 e301. 

Note also that there is some evidence that colony-stimulating factors may potentiate the pulmonary toxicity of bleomycin , (p.618) and cyclophosphamide , (p.625). 

These interaetions are not firmly established, but good pulmonary function monitoring appears to be advisable when colony-stimulating factors are used with antineoplastics causing pulmonary toxicity, such as bleomycin. If interstitial pneumonia occurs, the drugs should be discontinued and high-dose corticosteroids started immediately. More study is needed. Consider also Cyclophosphamide + Colony-shmulating factors , p.625. 

Granuloc i e colony-stimulating factor (G-CSF) used with cyclophosphamide has been associated with an increased occurrence of pulmonaiy toxicity. 

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