Cyclophosphamide, veno-occlusive

Veno-occlusive disease Azathioprine, dactinomycin, dacarbazine, cyclophosphamide... 

Veno-occlusive disease (VOD) differs from Budd-Chiari syndrome in that it consists of occlusive fibrosis of the small intrahepatic veins. VOD may present as either an acute form with sudden ascites, liver enlargement and rapidly rising bilirubin, or as a chronic form with fibrosis and cirrhosis. One of the main causes of VOD is the use of cyclophosphamide or alkalating agents during conditioning for bone marrow transplantation, where it occurs in up to 20% of cases. Other causes include irradiation, antineoplastic drugs, pyrrolizidine alkaloids and alcohol. 

K. G. Veno-occlusive disease of the Hver induced by low-dose cyclophosphamide. Modem Pathol. 1994 7 967-972... 

In 66 patients who received busulfan in combination with cyclophosphamide, etoposide, and/or cytarabine in preparation for bone marrow transplantation, there was a higher incidence of veno-occlusive disease of the liver (sinusoidal obstruction syndrome) in those who received busulfan + cyclophosphamide (four of 10) than in those who received busulfan + cyclophosphamide + cytarabine (one of 18) or busulfan + cyclophosphamide + etoposide (seven of 38) (24). The risk of veno-occlusive disease was higher in those whose busulfan AUC was over 1500 minute.pmol/l (relative risk = 11). Other pharmacokinetic parameters, age, sex, type of bone marrow transplantation, previous therapy, or pretransplant liver function tests were not predictive of veno-occlusive disease. 

Hepatic veno-occlusive disease was attributed to low-dose cyclophosphamide in a 2-year-old child, and in repeated episodes of serum transaminase fluctuations in a patient with hepatitis C virus infection (SEDA-19, 347). 

BUSULFAN CYCLOPHOSPHAMIDE t incidence of veno-occlusive disease and mucositis when cyclophosphamide is given <24 hours after the last dose of busulfan. Possibly also -L effect of cyclophosphamide There is i clearance and T elimination half-life of cyclophosphamide, and T concentrations of the active metabolite 4-hydroxycyclophosphamide Administer cyclophosphamide at least 24 hours after the last dose of busulfan... 

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