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PubMed1979

Treatment of micrometastases from Lewis lung carcinoma with abrin and cyclophosphamide, given singly and in combination.

The effect of the plant toxin abrin and of cyclophosphamide given as adjuvant chemotherapy after irradiation of the primary tumor was studied in mice bearing intramuscularly growing Lewis lung carcinoma. The chemotherapy was given immediately after irradiation performed 9 days after inoculation of 10(5) tumor cells. The drugs were given in bolus injections either as single agents or concurrently. The therapeutic effect was assessed by recording the appearance of lung metastases on day 21 or the number of long-term survivors, i.e. animals alive at day 60. In the control group 21 +/- 3.4 (SD) macroscopic lung colonies was recorded on day 21. Mean survival time was 25.5 days with none of the mice alive at day 60. The optimal abrin dose (612.5 ng/kg IV) reduced the number of lung metastases to 2.6 +/- 0.8 and yielded 37% long-term survivors (11/30). The optimal dose of cyclophosphamide (150 mg/kg IP) reduced the number of lung colonies to less than 1 and yielded 61% survivors (14/23). Small to moderate doses of abrin significantly potentiated the therapeutic effect of cyclophosphamide without increasing the toxicity. The best results (18/20 or 90% long-term survivors) were obtained when the optimal dose of cyclophosphamide, 150 mg/kg, was combined with 350 ng/kg of abrin. The results obtained in this highly resistant tumor suggest that combinations of the two drugs may be useful also in other tumor types.

Abrin↗

PubMed1994

Modulation of suppressor cell activities by cyclophosphamide in breast cancer patients.

We investigated the immunomodulatory effect of cyclophosphamide on the induction of suppressor cell activities in peripheral blood lymphocytes. The sera from advanced breast cancer patients as well as concanavalin-A (Con-A) induced suppressor cell activities in lymphocytes from healthy volunteers. Pretreatment of these lymphocytes, including CD4+ T cells with 4-hydroperoxycyclophosphamide (4-HC), an active form of cyclophosphamide, abrogated the induction of suppressor cell activities by either cancer sera or Con-A. A decrease in CD4+CD45RA+ suppressor/inducer T cells and reduction of Con-A induced suppressor cell activities were observed in breast cancer patients with metastases that were treated with cyclophosphamide (CPM). These results suggest that cyclophosphamide may modulate the immune responses of breast cancer patients by interference with suppressor/inducer T cells.

Breast Neoplasms↗

PubMed1992

Continuous-infusion 5-fluorouracil combined with doxorubicin and cyclophosphamide: feasibility study.

Previous studies have demonstrated continuous-infusion 5-fluorouracil (CI 5-FU) to be an active single-agent treatment for breast cancer without significant myelotoxicity. These qualities made CI 5-FU an attractive agent for combination with other effective but myelosuppressive agents. In this study we attempted to determine the maximal doses of CI 5-FU that could be added to a combination of agents known to be dose limited by myelotoxicity, doxorubicin 50 mg/m2 day 2 and cyclophosphamide 150 mg/m2 days 3-12 of a 28-day cycle. Patients who received doxorubicin and cyclophosphamide alone developed significant myelotoxicity but did not develop stomatitis. The addition of 5-7 days of CI 5-FU at 200-300 mg/m2 was associated more closely with increased stomatitis (P = .11) than with increased granulocytopenia (P = .57). The stomatitis observed for low doses of CI 5-FU given with doxorubicin and cyclophosphamide would not have been expected for these low doses of CI 5-FU given as a single agent. We conclude that the addition of CI 5-FU to myelotoxic doses of doxorubicin and cyclophosphamide is not a promising therapeutic strategy for significantly increasing the effectiveness of this combination of agents.

Adenocarcinoma↗

PubMed1994

Acute myeloid leukemia in patients treated for rhabdomyosarcoma with cyclophosphamide and low-dose etoposide on Intergroup Rhabdomyosarcoma Study III: an interim report.

The early occurrence of five cases of acute myeloid leukemia (AML) in children treated for primary rhabdomyosarcoma on the Intergroup Rhabdomyosarcoma Study III (IRS III) has prompted this report. These patients received cyclophosphamide and four received etoposide in addition to other agents. There were 1,062 eligible patients entered on IRS III between 1984 and 1991. Following surgery, treatment consisted of multiagent chemotherapy and radiotherapy in select clinical groups. Median follow-up time is 3.7 years (range 0-7.4 years). Incidence densities and odds ratios for AML were calculated for various treatment groups. Five cases of secondary AML have been reported through August 1992. A single case of osteogenic sarcoma was reported in the same period and a patient with myelodysplastic syndrome has occurred since that time. Median time to development of AML was 39 months. Incidence density of AML for patients receiving neither cyclophosphamide nor etoposide was 0, for those receiving cyclophosphamide but no etoposide it was 7.6, and when both agents were given, it was 51.6. The odds ratios of AML for the latter two groups indicated a risk of AML which was seven times higher in the patients who received both agents. A history of breast cancer was present in all five families of patients with AML and several other cancers had occurred in three families. Preliminary analysis suggests a possible causal role for low-dose etoposide in addition to that assumed for cyclophosphamide in the early development of AML among pediatric patients treated for rhabdomyosarcoma.

Adolescent↗

PubMed1995

Cyclophosphamide in combination with sargramostim for treatment of recurrent medulloblastoma.

Thirteen patients with recurrent medulloblastoma were treated with cyclophosphamide in association with Sargramostim. Cyclophosphamide was given at doses ranging between 1.0-2.5 g/m2 daily for two doses. Sargramostim was given at a fixed dose of 250 micrograms/m2 subcutaneously twice a day beginning 24 hours after the second cyclophosphamide dose and continuing through the leukocyte nadir until the ANC was more than 1,000 cells/microliters for two consecutive days. A total of 33 courses were given with toxicity consisting of grade 4 neutropenia in all courses and grade 3-4 thrombocytopenia in 10 of 13 patients. There were no deaths related to infection or bleeding. Four patients were taken off study because of prolonged myelosuppression. Three of these patients were at the 2.5 g/m2 level, and of these three, two developed lung toxicity (grades 2 and 4, respectively). One patient developed an allergic reaction following the first injection of Sargramostim and was also taken off study. Of 10 evaluable patients, there were 9 PR and 1 SD. We conclude that cyclophosphamide at a dose of 2.0 g/m2/day x 2 days q 4 weeks in association with Sargramostim demonstrates marked activity with acceptable toxicity in patients with recurrent medulloblastoma.

Adolescent↗

PubMed2006

High-dose cyclophosphamide without stem cell rescue for refractory multifocal motor neuropathy.

Patients with multifocal motor neuropathy (MMN) respond to intravenous immune globulin (IVIg) and cyclophosphamide, although the benefit is not sustained. High-dose cyclophosphamide can induce a remission in patients with autoimmune diseases, including chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We describe a patient with refractory MMN who improved with high-dose cyclophosphamide (50 mg/kg for 4 days) without stem cell rescue. Following treatment she discontinued IVIg. At a 6-month examination, her strength had improved and she had regained the ability to write. High-dose cyclophosphamide may be a successful treatment for patients with MMN refractory to other therapies.

Antineoplastic Agents↗

PubMed2004

Phase I study of oral cyclophosphamide and oral topotecan for children with recurrent or refractory solid tumors.

BACKGROUND: To determine the maximum-tolerated duration and dose-limiting toxicity of a daily schedule of orally administered cyclophosphamide and topotecan in pediatric patients with recurrent or refractory malignant solid tumors. METHODS: Patients received oral cyclophosphamide (50 mg/m2/dose) in the morning followed by topotecan (0.8 mg/m2/dose) 8-12 hr later for an escalating number of consecutive days (10, 14, and 17 days). RESULTS: Seventeen pediatric patients were treated with oral cyclophosphamide and topotecan for durations of 10-17 days for a total of 58 treatment courses. Reversible hematologic toxicity (neutropenia and thrombocytopenia) was the dose-limiting toxicity. Nonhematologic toxicities of greater than grade 3 were not observed. A partial response (neuroblastoma following myeloablative chemotherapy and stem cell rescue) and prolonged stable disease (medulloblastoma) were each observed in one patient. CONCLUSIONS: The recommended duration of therapy with a daily schedule of both oral cyclophosphamide (50 mg/m2/day) and topotecan (0.8 mg/m2/day) for previously treated pediatric patients with recurrent or refractory solid tumors is 14 consecutive days. The observed dose limiting toxicity (DLT) was reversible neutropenia. This regimen was well tolerated in heavily pretreated patients and demonstrated activity against recurrent pediatric solid tumors.

Administration, Oral↗

PubMed2006

Two infants with life-threatening diffuse neonatal hemangiomatosis treated with cyclophosphamide.

Diffuse neonatal hemangiomatosis (DNH) is a rare, frequently fatal disorder characterized by multiple cutaneous and visceral hemangiomas. Complications include high-output cardiac failure, hemorrhage, hepatic failure, and consumption coagulopathy. We present two cases of neonates with DNH. We prescribed cyclophosphamide after failure of corticosteroids. Cyclophosphamide induced a fast regression of the lesions with no side effects in both infants. We were able to stop treatment after 3-4 courses of cyclophosphamide in both infants because of the excellent response. Cyclophosphamide seems to be a safe and effective treatment in patients suffering from life-threatening DNH unresponsive to corticosteroids.

Adrenal Cortex Hormones↗

PubMed1993

Teratogenicity and carcinogenicity in a twin exposed in utero to cyclophosphamide.

A 29-year-old pregnant woman diagnosed with acute lymphocytic leukemia maintained remission with daily cyclophosphamide and intermittent prednisone treatment. She delivered a male twin with multiple congenital abnormalities who was diagnosed with papillary thyroid cancer at 11 years of age and stage III neuroblastoma at 14 years of age. The female twin was unaffected and has exhibited normal development to date. First trimester exposure to cyclophosphamide has been associated with major malformations. Metabolites of cyclophosphamide have been demonstrated to be teratogens and carcinogens in animals. Differences in placental or fetal hepatic cytochrome P-450 may account for the variability in response between the twins. In addition, disparity between the twins may be the result of differences in metabolite inactivating enzymes present either in fetal liver or placenta. The risk of second malignancies caused by alkylating agents such as cyclophosphamide has been well documented in adults and children but to the best of our knowledge this is the first description of transplacental second cancer.

Abnormalities, Drug-Induced↗

PubMed1995

Suppressing effect of WR-2721 on micronuclei induced by cyclophosphamide in mice.

The effect of WR-2721 against cyclophosphamide-induced clastogenicity was studied using the in vivo micronucleus assay. The frequency of micronuclei in polychromatic erythrocytes in the peripheral blood of mice treated with WR-2721 and cyclophosphamide (CP), each of the compounds at a dose of 200 mg/kg body weight, was evaluated during the 15-day period. The suppressing effect of WR-2721, given 30 min prior to cyclophosphamide administration, on micronuclei induced by the alkylating agent was demonstrated. The number of micronuclei was increased on day 1 after CP application and declined thereafter with the frequency of micronucleated polychromatic erythrocytes remaining lower in WR-2721 pre-treated mice. The modulatory effect of WR-2721 on the clastogenic activity of cyclophosphamide in the erythropoietic system by the mouse micronucleus test was shown.

Amifostine↗

PubMed1989

Embryotoxicity of phenyl ketone analogs of cyclophosphamide.

Phenylketophosphamide and phenylketoisophosphamide are preactivated acyclic ketone analogs of cyclophosphamide and isophosphamide with antitumor activity. These compounds undergo an elimination reaction to yield phosphoramide or isophosphoramide mustard and phenyl vinyl ketone. In this study, the embryotoxicity of phenylketophosphamide, phenylketoisophosphamide, and phenyl vinyl ketone were determined. Embryotoxicity was assessed in vitro in whole rat embryos cultured on day 10.5 of gestation in the absence and presence of an activating system derived from maternal liver. Both phenylketophosphamide and phenylketoisophosphamide were embryotoxic in the absence of metabolic activation. Moreover, there was no enhancement of this embryotoxicity in the presence of an activating system. A 10-microM concentration of phenylketophosphamide produced 100% malformed embryos, while this concentration of phenylketoisophosphamide was not teratogenic. At 25 microM phenylketoisophosphamide, all the surviving exposed embryos were malformed. Phenylketophosphamide was embryolethal to more than 50% of the exposed embryos at a concentration of 50 microM. In contrast, a concentration of phenylketoisophosphamide of 100 microM was required to produce significant embryolethality. Phenyl vinyl ketone was not embryotoxic at any of the concentrations tested. The major malformation observed, a hypoplastic prosencephalon, and the growth retardation effects were not only similar for phenylketophosphamide and phenylketoisophosphamide, but also similar to those previously reported for "activated" cyclophosphamide. Unlike the results with cyclophosphamide, where both phosphoramide mustard and the aldehydic metabolite of cyclophosphamide, acrolein, are toxic, the embryotoxic effects of phenylketophosphamide and phenylketoisophosphamide are mediated only by the mustard metabolite.

Animals↗

PubMed2000

Clarithromycin attenuates cyclophosphamide-induced mucositis in mice.

No universally recognized agent is available for prophylaxis or therapy of mucositis induced by chemotherapy or chemo-radiotherapy. The effect of clarithromycin on the severity of mucositis induced by cyclophosphamide was investigated using a mouse model. Four cross-sections of small intestine (levels A, B, C, and D) were taken at equivalent intervals at day 5 after cyclophosphamide (400 mg kg(-1)) administration. The sections were stained with haematoxylin and eosin, and were graded for the degree of mucositis histologically. At section level B, the number of mice with no mucositis (grade 0) in the clarithromycin group was significantly greater than that in the ceftriaxone group (P<0.05). At levels B and C, the number of mice with no mucositis (grade 0) in the clarithromycin group was significantly greater than that in the normal saline (NS) group (P<0.05). At level C, the number of mice with grade 2 mucositis in the ceftriaxone group was significantly greater than that in the NS group (P<0.05). When the number of sections at all levels were analyzed together, the number of mice with no mucositis (grade 0) in the clarithromycin group was significantly greater than that in the ceftriaxone and NS groups (P<0.05). The present observation suggests that clarithromycin and ceftriaxone attenuates and aggravates cyclophosphamide-induced mucositis. It prompts clinical trials in bone marrow transplant (BMT) recipients receiving cyclophosphamide for conditioning, and reconsideration in the use of ceftriaxone in the treatment of neutropenic fever in BMT recipients.

Animals↗

PubMed1989

Augmentation of host antitumor immunity by low doses of cyclophosphamide and mafosfamide in two animal tumor models.

By cloning in vitro we have obtained two sublines of the L5222 rat leukemia, one with high (L5222-S) and the other with low (L5222-R) in vivo sensitivities to non-toxic doses of mafosfamide, a stabilized derivative of 4-hydroxy-cyclophosphamide. This sensitivity in vivo was not related to the cytotoxic activity of the drug in vitro. Treatment of rats bearing the L5222-S and of mice transplanted with the MOPC-315 plasmocytoma with low doses of mafosfamide or cyclophosphamide resulted in a high percentage of surviving animals, which were resistant to a subsequent tumor challenge. Viable leukemic cells were needed to establish antitumor immunity, since it was not possible to induce resistance by injection of mitomycin-C-treated, non-viable L5222 cells. The adoptive transfer of spleen cells from animals immune against the L5222-S and the MOPC-315 resulted in resistance of the syngeneic recipients against a rechallenge with tumor cells, provided that the animals were treated with an immunosuppressive dose (100 mg/kg) of cyclophosphamide prior to the spleen cell implantation. In nude mice treatment of the L5222 with low doses of mafosfamide also resulted in surviving animals, however resistance to a second tumor challenge occurred only sporadically. The data presented confirm that therapy with cyclophosphamide or mafosfamide enhances host antitumor immunity but, contrary to previous reports, it could be demonstrated that successful tumor rejection was independent of T cells.

Adjuvants, Immunologic↗

PubMed1987

High-dose cyclophosphamide followed by cisplatinum in the treatment of ovarian cancer.

Twenty patients with previously untreated ovarian cancer received intensive chemotherapy after initial surgery. Treatment comprised two courses of cyclophosphamide at 7 g/m2 with mesna, re-evaluation with second-look laparotomy where appropriate, followed by five courses of cisplatin at 100 mg/m2. Three patients achieved pathologically documented complete remission (PDCR) with high-dose cyclophosphamide, and eight patients achieved partial remission. Fifteen patients went on to receive cisplatin. Nine of these patients had no assessable disease; of six patients who were assessed for response two achieved PDCR and three achieved partial remission. The overall response rate to the sequential regimen was 14/20 (70%). High-dose cyclophosphamide was associated with marked haematological toxicity, which was cumulative and fatal in two patients. The median duration of first remission was 14 months, and the median duration of survival was 20 months. It is concluded that sequential treatment with high-dose cyclophosphamide and cisplatin appears to be no more effective than conventional treatment in advanced ovarian cancer, judging by the PDCR rate and median survival achieved.

Adult↗

PubMed1982

Metabolism of high doses of cyclophosphamide.

The excretion of cyclophosphamide and the enzymatically derived metabolites 4-ketocyclophosphamide and carboxyphosphamide has been measured in four patients after the administration of cyclophosphamide (5 g). At this dose the enzymes responsible for the biotransformation and detoxification of cyclophosphamide are not saturated. In two patients the metabolite profile was unaffected by a previous high dose of cyclophosphamide and in one patient a small primary dose did not alter metabolism.

Cyclophosphamide↗

PubMed1979

Synthesis and preliminary antitumor evaluation of 4-(SR)-sulfido-cyclophosphamides.

Crystalline 4-(SR)-sulfidocyclophosphamides, sulfido derivatives of activated cyclophosphamide (4-hydroxycyclophosphamide), were synthesized by ozonation of cyclophosphamide and reaction of the intermediate 4-hydroxycyclophosphamide with various thiols (HSR). The products were characterized by elemental analysis, 1H NMR and IR spectroscopy, and mass spectrometry. 1H NMR and polarimetric analysis demonstrated that they consist of racemic cis-isomers that are stable in the crystalline state at room temperature. In aqueous solution these derivatives are hydrolyzed to 4-hydroxycyclophosphamide and the corresponding thiol, with half-lives ranging between 4 and 17 min at 37 degrees C and pH 7. The cytotoxicity of 4-(S-ethyl)- and 4-(S-ethanol)-sulfidocyclophosphamide against Yoshida sarcoma ascites cells and the toxicity in rats were found to be practically identical with those of activated cyclophosphamide. A preliminary evaluation of the curative effect after a single IV injection of 4-(S-ethane)- and 4-(S-ethanol)-sulfidocyclophosphamide in rats bearing Yoshida ascites sarcoma or of 4-(S-ethanol)-sulfidocyclophosphamide in nu/nu mice bearing human breast carcinoma xenografts suggested that these sulfido derivatives possess the same oncostatic efficacy as activated cyclophosphamide itself.

Animals↗

PubMed1984

Promotion of spontaneous diabetes in non-obese diabetes-prone mice by cyclophosphamide.

Cyclophosphamide promoted the onset of overt diabetes in non-obese diabetes-prone mice of both sexes. Two injections of this agent at 2 weeks apart were necessary to obtain a constant high incidence, although even a single injection was effective in some animals. Clinical symptoms of the cyclophosphamide-induced diabetes were similar to those of the naturally occurring type. The same schedule of cyclophosphamide treatment failed to induce diabetes in non-diabetic mouse strains, such as DS/Shi,Jcl:ICR or in non-obese non-diabetes-prone mice, which suggests that the promotion of diabetes by cyclophosphamide in non-obese diabetes-prone mice is not due to the simple pharmacological action of this agent but to some immunopharmacological action.

Animals↗

PubMed1976

Investigations on the frequency of chromosome aberrations in bone marrow cells of chinese hamsters after simultaneous application of caffeine and cyclophosphamide.

The potentiating effect of caffeine (1,3,7-trimethylxanthine) on chemically induced chromosome aberrations was studied in bone marrow cells of chinese hamsters, exposed to the alkylating agent cyclophosphamide. Four experimental series were performed: In the first two tests caffeine (200 mg/kg) or cyclophosphamide (40 mg/kg), respectively, were administered. A third and fourth test was performed with caffeine plus cyclophosphamide (200 + 40 mg/kg and 35 + 40 mg/kg, respectively) simultaneously. Aberrations induced by cyclophosphamide (40 mg/kg) were strongly potentiated by simultaneous application of caffeine (200 mg/kg) not only additively but even synergistically. This increase of aberrations cannot be found after injection of the lower dose of caffeine (35 mg/kg).

Animals↗