How it Works

Cyclophosphamide is classified as a “cytotoxic agent” because it has a toxic effect on many types of cells (“good” cells as well as “bad”). Cyclophosphamide is one of several medications first developed as a chemotherapy medication used to treat various cancers, including acute myeloid leukemia (AML) and multiple myeloma. Cyclophosphamide works by attacking the DNA of cancer cells and disrupting their ability to divide and grow.

It was discovered that — in addition to its usefulness in cancer — cyclophosphamide also has a significant ability to suppress the immune system. This medicine is very effective in treating immunologically–mediated diseases, including some forms of inflammation in your blood vessels (Vasculitis), and before procedures like stem cell transplants. In general, much lower doses of cyclophosphamide are used to treat vasculitis than are used to treat cancer. However, the doses of cyclophosphamide used to treat vasculitis are still high enough to cause a significant number of side–effects, and the drug must be used with great caution.

How it’s Administered

Cyclophosphamide can be given by a number of different routes. The route that it is given depends on the dosage, the condition being treated, and the purpose it is being used for. Depending upon the diagnosis, it is usually given through a vein by injection or infusion (intravenous, IV) or by mouth in tablet form. Cyclophosphamide is also approved to be given by a shot into a muscle (IM), into the abdominal lining (intraperitoneal, IP), or into the lining of the lung (intrapleural). Tablets should be given with food or after meals. Tablets should not be cut or crushed. In multiple myeloma and acute myeloid leukemia, it is most commonly administered IV. 

Who Should Take Cytoxan

Cytoxan is currently approved for  Hodgkin's and non-Hodgkin's lymphoma, Burkitt's lymphoma, chronic lymphocytic leukemia (CLL), chronic myelocytic leukemia (CML), acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), t-cell lymphoma (mycosis fungoides), multiple myeloma, neuroblastoma, retinoblastoma, breast cancer, ovarian cancer, and conditioning regimens for bone marrow transplantation.

Who Shouldn’t Take Cytoxan

Conditions:

• A bacterial infection
• Chickenpox
• Shingles
• Opportunistic fungal infection
• An infection due to a protozoa organism
• An infection due to a parasite
• Myeloproliferative neoplasm
• Low amount of sodium in the blood
• Dehydration
• Anemia
• Decreased blood platelets
• Low levels of white blood cells
• Low levels of a type of white blood cell called neutrophils
• Heart muscle disease caused by the medication doxorubicin
• Liver problems
• Uric acid kidney stones
• Inflammation of the bladder with hemorrhage
• Inflammation and bleeding of the bladder due to chemotherapy
• Bloody urine
• A high amount of uric acid in the blood
• Pregnancy
• A patient who is producing milk and breastfeeding
• Obstruction of any part of the urinary tract
• Kidney disease with likely reduction in kidney function
• An increased risk of developing an uncommon viral infection called an opportunistic infection

The Most Common Side Effects of Taking Cytoxan Include: 

More common

• Cough or hoarseness
• Fever or chills
• Lower back or side pain
• Missing menstrual periods
• Painful or difficult urination

With high doses and/or long-term treatment

• Blood in the urine
• Dizziness,  confusion, or agitation
• Fast heartbeat
• Joint pain
• Shortness of breath
• Swelling of the feet or lower legs
• Unusual tiredness or weakness

Less common

• Black, tarry stools
• Pinpoint red spots on the skin
• Unusual bleeding or bruising

Rare

• Frequent urination
• Redness, swelling, or pain at the injection site
• Sores in the mouth and on the lips
• Sudden shortness of breath
• Unusual thirst
• Yellow eyes or skin

Commonly Used in Myeloma With

• Steroids
• Revlimid
• Velcade
• Pomalidomide
• Dexamethasone
• Carfilzomib
• Ixazomib

Commonly Used in AML With

• Busulfan or total body irradiation (TBI) before a stem cell transplant

Commonly Being Tested in Myeloma With

• Proteasome Inhibitors: Ixazomib, Carfilzomib
• Corticosteroids: Dexamethasone, Prednisone
• Immunomodulators (IMiDs): Pomalidomide, Iberdomide
• Antibody-Drug Conjugates: Belantamab Mafodotin

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