Cyclophosphamide

Cytostatic, immunosuppressive.

4–8 h

Inhibition of DNA synthesis, humoral and cellular immune response (suppression of skin reaction of subjects sensitized to DNCB and tuberculin), reduction of cytotoxic T lymphocytes and CD8 cells. Prodrug; is transformed to the effective metabolite phosphoramide mustard only in the liver.

As a chemotherapeutic agent for acute and chronic lymphatic leukaemia, soft tissue and bone sarcoma, and Hodgkin's disease.

As an immunosuppressive agent for therapy-refractory autoimmune diseases such as.

• Systemic Lupus Erythematodes (SLE)
• progressive scleroderma
• Dermatomyositis (MDA5 pos.)
• Vasculitides like granulomatosis with polyangiitis
• Rheumatoid Arthritis

Furthermore as:

• conditioning treatment before stem cell transplantation and immunotherapy
• Mobilisation of stem cells for stem cell apheresis

Remember! In no way is cyclophosphamide an immunosuppressive agent of first choice in the treatment of collagenosis. It should only be used after failure or when other immunosuppressive drugs are contraindicated!

According to chemotherapy protocol: CP-scheme, COP-scheme, COPP-scheme, CAPO-scheme, CHOP-scheme, MOPP-scheme.

As immunosuppressive agent 50-100 mg/day p.o. or pulse therapy with 500-1000 mg i.v. every 2-4 weeks under bladder protection with mesna (20% of the cyclophosphamide dose at 0, 4 and 8 hours after cyclophosphamide administration is recommended). Restricted kidney function requires a dose reduction.

Notice! Before therapy: BB and check kidney and liver function!

Cutaneous ADR: Very often urticarial exanthema, reversible alopecia, hyper- or hypopigmentation especially on palms, fingernails and soles.

Haematological ADRs: BB changes (max. day 9-12, recovery on day 15); lymphomas (secondary tumors), leukemia

Gastroenterological ADR: gastrointestinal disorders, hepatitis, gallbladder carcinoma,

UrologicalUAW: cystitis, bladder fibrosis,

Other ADRs: headache, stomatitis, pulmonary fibrosis, azoospermia, anovulation

Remember! Male patients: Before starting therapy and after the end of therapy a spermiogram should be taken. Draw attention to the possibility of cryopreservation of sperm! Risk of permanent damage to the gonads!

The blood sugar lowering effect of oral antidiabetics and the myelotoxic effect of myelotoxic substances are increased.

Pregnancy, lactation, severe bone marrow depression, severe infections.

Endoxan®

1. Grunewald S et al (2007) Systemic dermatological treatment with relevance for male fertility. J Dtsch Dermatol Ges 5: 15-21