Cyclophosphamide, also known as cytophosphane, appears as a white to almost white crystalline powder with a slightly bitter taste. The chemical name of it is p-[N,N-bis-(2-chloroethyl)]-1-oxo-3-nitrogen-2-phosphocyclohexane-p-oxide monohydrate. Cyclophosphamide is a synthetic alkylating agent chemically related to nitrogen mustard with antineoplastic and immunosuppressive activities, which was approved for medical use in the United States in 1959. The structure is shown in fig. 1.
Cyclophosphamide remains one of the most successful and widely utilized antineoplastic drugs. It is used in chemotherapy to treat lymphoma, multiple myeloma, ovarian cancer, leukemia, breast cancer, small cell lung cancer, neuroblastoma, and sarcoma. Cyclophosphamide is an inactive prodrug that requires enzymatic and chemical activation. The resultant nitrogen mustard produces interstrand and intrastrand DNA crosslinks that block DNA synthesis. The detailed mechanism of action is shown in fig. 2.
Low-dose cyclophosphamide has been used effectively in a variety of autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, scleroderma, and multiple sclerosis. It induces beneficial immunomodulatory effects in adaptive immunotherapy. For autoimmune diseases, the mechanisms of action of cyclophosphamide may include:
Common side effects of cyclophosphamide mainly include:
Other side effects of cyclophosphamide mainly include:
Slow-healing existing wounds
Decreased urine output
Unusual tiredness or weakness
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