Cyclophosphamide dosing

Bolus 40% of cyclophosphamide dose given IV at hours 0, 3, 6, and 9 after cyclophosphamide... 

Mesna (Mesnex) [Uroprotectant/Antidote] Uses Prevent hem-orrhagic cystitis d/t ifosfamide or cyclophosphamide Action Antidote, reacts w/ acrolein and other metabolites to form stable compounds Dose Per protocol dose as % of ifosfamide or cyclophosphamide dose Oral 20% IV dose at 0, 4, 8 h (mix w/ juice) Caution [B /—] Contra Thiol sensitivity Disp Inj, tabs SE -i- BP, allergic Rxns, HA, GI upset, taste p v sion EMS Antidote for two antineoplastic drugs (ifosfamide and cyclophosphamide) OD May cause D, muscle tremors, SOB, bluish skin color, and Szs symptomatic and supportive... 

Hemorrhagic cystitis (chronic low-dose cyclophosphamide) PO 20 mg/kg q3-4h Hemorrhagic cystitis (high-dose cyclophosphamide) IV 40% of cyclophosphamide dose at 0, 3,6, 9 hr and IV fluids. 

Electrolyte balance In a retrospective analysis of data obtained from 84 patients with lupus nephritis or non-Hodgkin s lymphoma, 112 treatment episodes with low-dose intravenous pulse cyclophosphamide (500-750 mg/m ) were evaluated [28. All received 0.45% saline as hydration to prevent hemorrhagic cystitis. There was cyclophosphamide-induced hyponatremia during 15 treatment episodes in 12 patients. Patients with hyponatremia were significantly older than those without, although no factors independently predicted hyponatremia in a multivariate analysis, including cyclophosphamide dose. Cyclophosphamide potentiates the renal action of vasopressin, thereby reducing the ability of the kidney to excrete water, which should warrant the use of hypotonic solutions for prophylactic hydration to prevent hyponatremia. 

Cyclophosphamide 600 mg/m2 IV, day 1 Methotrexate 40 mg/m2 IV, day 1 Fluorouracil 600 mg/m2 IV, days 1 and 8 Repeat cycles every 28 days for 6 cycles Dose-dense AC —> paclitaxel Doxorubicin 60 mg/m2 IV bolus, day 1 Cyclophosphamide 600 mg/m2 IV, day 1 Repeat cycles every 14 days for 4 cycles (must be given with growth factor support) Followed by ... 

CAV, cyclophosphamide, doxorubicin, vincristine EC, etoposide carboplatin EP, etoposide cisplatin IC, irinotecan, cisplatin. See Table 87M for doses and schedules. 

BCV (high-dose with autologous stem cell transplant)3 Carmustine 400 mg/m2 IV x 1 day Etoposide 800 mg/m2 IV daily x 3 days Cyclophosphamide 1800 mg/m2 IV daily x 4 days... 

More recently, a German study compared a dose-escalated regimen of BEACOPP (with filgrastim support) with standard-dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone, gemcitabine (BEACOPP) and COPP alternating with ABVD (C—cyclophosphamide instead of mechlorethamine for MOPP).18 The escalated BEACOPP was... 

There are certain histologic subtypes of diffuse, aggressive NHL that respond less well to treatment with conventional regimens such as CHOP. Burkitt s lymphoma, lymphoblastic lymphoma, mantel cell lymphoma, and primary CNS lymphoma are examples of disease that benefit from more intensive therapy. Regimens such as hyper-CVAD, which alternate cycles of hyperfractionated cyclophosphamide, doxorubicin, vincristine, and dexamethasone with high-dose cytarabine and methotrexate, often are substituted for CHOP. Intrathecal therapy with methotrexate is indicated with documented CNS infiltration of tumor or involvement of the sinuses. The recent appreciation of the etiology of Helicobacter pylori in the etiology of peptic ulcer disease and the association between colonization and mucosal-associated lymphoma (MALT) has spurred... 

Select azole antifungals (e.g., itraconazole, voriconazole, and posaconazole) and the echinocandins are available for IA treatment. For initial therapy of IA, voriconazole had higher response and survival rates than c-AMB.102 An advantage of voriconazole is its 96% oral bioavailability, making use of this oral drug an attractive and less expensive alternative. The dose of voriconazole was 6 mg/kg IV every 12 hours for two doses, followed by 4 mg/kg IV every 12 hours for at least 7 days, at which time oral voriconazole 200 mg every 12 hours could be administered. Common toxicities reported with voriconazole include infusion-related, transient visual disturbances (i.e., blurred vision, altered color perception, photophobia, and visual hallucinations), skin reactions (i.e., rash, pruritus, and photosensitivity), elevations in hepatic transaminases and alkaline phosphatase, nausea, and headache.102 In addition, voriconazole increases the serum concentrations of medications cleared by cytochrome P-450 2C9, 2C19, and 3A4 (e.g., cyclophosphamide and calcineurin inhibitors) concomitant voriconazole-sirolimus should be avoided.103... 

BR arrives at the clinic to receive her first dose of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) at full doses. 

Continuous bladder irrigation by catheterization uses normal saline at 250 to 1000 mL/hour to flush acrolein from the bladder. Hyperhydration with normal saline at 3 L/m2 per day with intravenous furosemide to maintain urine output greater than 100 mL/hour also has been used with cyclophosphamide. Mesna is equivalent to both strategies in patients receiving high-dose cyclophosphamide and avoids the discomfort and... 

TABLE 96-9. ASCO Guidelines for the Use of Mesna with Ifosfamide and High-Dose Cyclophosphamide... 

High-dose cyclophosphamide (bone marrow transplant)... 

Neutropenia is a condition characterized by a decrease in blood neutrophil count below 1.5 X 109 cells per litre a normal blood count is (2.0-7.5) X 109 cells per litre. Its clinical symptoms include the occurrence of frequent and usually serious infections, often requiring hospitalization. Neutropenia may be caused by a number of factors (Table 10.6), at least some of which are responsive to CSF treatment. Particularly noteworthy is neutropenia triggered by administration of chemotherapeutic drugs to cancer patients. Chemotherapeutic agents (e.g. cyclophosphamide, doxorubicin and methotrexate), when administered at therapeutically effective doses, often induce the destruction of stem cells and/or compromise stem cell differentiation. 

Standard combination regimens (e.g., CHOP) yield disappointing results. Newer approaches including dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin), and rituximab-containing combination chemotherapy are promising. 

Hutchings, R, Nador, D., and Cooke, A. (1985). Effects of low doses of cyclophosphamide and low doses of irradiation on the regulation of induced erythrocyte autoantibodies in mice. Immunology 54 97-104. 

THC is effective in several chemotherapy regimens, including methotrexate and the doxorubicin/cyclophosphamide/fluorouracil combination. Cisplatin treatment, however, is more resistant. Side effects of THC are generally well tolerated, and use may be limited in the elderly or with higher doses. Nabilone is a synthetic cannabinoid that is more effective than prochlorperazine in chemotherapy-induced emesis, including cisplatin. Its side effects are similar to THC. Levonantradol is another synthetic cannabinoid with antiemetic effects, and may be administered orally or intramuscularly. The side effect of dysphoria may limit its use. 

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