Cyclophosphamide thrombocytopenia

Cyclophosphamide s major toxic effect is myelosuppression resulting in blood dyscrasias, such as leukopenia, anemia, thrombocytopenia, and hypoprothrom-binemia. 

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... 

Issac C, Robert NJ, Bailey FA, Schuster MW, et al. 1997. Randomized placebo-controlled study of recombinant human interleukin 11 to prevent chemotherapy induced thrombocytopenia in patients with breast cancer receiving dose-intensive cyclophosphamide and doxorubicin. J Clin Oncol. 15 3368-3377. 

Cyclophosphamide Cytoxan, Neosar Acute and chronic lymphocytic leukemia acute and chronic myelocytic leukemia carcinoma of ovary, breast Hodgkin disease non-Hodgkin lymphomas multiple myeloma Blood disorders (anemia, leukopenia, thrombocytopenia] Gl distress (nausea, vomiting, loss of appetite] bladder irritation hair loss car-diotoxicity pulmonary toxicity... 

Adverse Effects. Cyclophosphamide is used very cautiously as an immunosuppressant because of the possibility of severe side effects, including carcinogenic effects during long-term use. Other side effects include hematologic disorders (leukopenia, thrombocytopenia), cardiotoxicity, nephrotoxicity, and pulmonary toxicity. 

CYCLOPHOSPHAMIDE PACLITAXEL t risk of neutropenia, thrombocytopenia and mucositis when paditaxel is infused over 24 or 72 hours prior to cyclophosphamide Mechanism is uncertain Administer cyclophosphamide first and then follow with paditaxel... 

Leukopenia, and less commonly thrombocytopenia or anemia, due to cyclophosphamide are typically dose-related in the therapeutic range. Cyclophosphamide-induced anemia has led to retinopathy presenting as striated hemorrhage of the retina (12). 

A 72-year-old man with autoimmune thrombocytopenia had taken prednisone (30 mg/day) for 1 year, when he was found to have systemic lupus erythematosus (46). Prednisone was continued and he started to take chloroquine (250 mg/day) and monthly cyclophosphamide (0.75 g/m ). Three weeks after the first bolus of cyclophosphamide, he complained of fever and dyspnea, and chest X-rays showed bilateral pulmonary infiltrates. Despite prompt medical management, he died 5 days after admission with cytomegalovirus-induced interstitial pneumonia. 

Leo E, Scheuer L, Schmidt-Wolf IG, Kerowgan M, Schmitt C, Leo A, Baumbach T, Kraemer A, Mey U, Benner A, Parwaresch R, Ho AD. Significant thrombocytopenia associated with the addition of rituximab to a combination of fludarabine and cyclophosphamide in the treatment of relapsed follicular lymphoma. Eur J Haematol 2004 73(4) 251-7. 

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). 

A study in which intravenous methotrexate, cyclophosphamide and fluor-ouracil (CMF) were used within 36 hours of mastectomy suggested that stomatitis may be caused by a toxic interaction between methotrexate and nitrous oxide used during anaesthesia. Stomatitis was much more common in those receiving CMF within 6 hours of surgery. " A possible reason is that the effects of methotrexate on tetrahydrofolate metabolism are increased by nitrous oxide, and this has been confirmed in animals It was found that the incidence of stomatitis, severe leucopenia, thrombocytopenia, and of severe systemic and local infections could be reduced by giving calcium folinate (leucovorin) and intravenous hydration. Alternatively, the use of nitrous oxide shortly before methotrexate administration should be avoided. ... 

A study in patients given paclitaxel as a 24-hour infusion and cyclophosphamide as an infusion over 1 hour found that neutropenia and thrombocytopenia were more severe when paclitaxel preceded cyclophosphamide. Similarly, in another study, concurrent use of a continuous 72-hour infusion of paclitaxel and a daily bolus of cyclophosphamide had acceptable toxicity. However, when the cyclophosphamide was given as a single intravenous dose after the end of the 72-hour paelitaxel infusion, severe haematological and gastrointestinal toxieity occurred. Whether the clinical efficacy of this combination is also altered by the schedule and sequence has not been determined. See also Cyclophosphamide or Ifosfamide + Taxanes , p.628. 

In a retrospective study in 21 patients with refractory pemphigus who were treated with intravenous methylprednisolone for 3 consecutive days at monthly intervals plus intravenous cyclophosphamide 500 mg on day 2, the most common adverse reaction was transient lymphopenia or thrombocytopenia (12 of 21 patients) [26 ]. In two patients, this necessitated a dosage reduction of cyclophosphamide. Other reversible abnormalities included hypokalemia (n=4). There were generally mild post-infusion symptoms of fatigue, headache, and fever in seven patients, which necessitated a dosage reduction in one. One patient had had three pulses when treatment was halted prematurely because of recurrent pneumonia another withdrew after five pulses as she developed premature ovarian failure and two patients had premature menopause, in whom cyclophosphamide was not withdrawn. There were seven episodes of sepsis during therapy, which were mild and responded to antibiotics. There were two cases of localized herpes zoster infection and one of bronchial... 

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