Paper II
2021 February (Supplementary) (2010 Scheme)

Question

Cyclophosphamide

Q53 marksShort Notes

Answer

Cyclophosphamide is an alkylating agent, used as an anticancer and immunosuppressant drug.

Mechanism of action

  • Prodrug, activated hepatically to phosphoramide mustard, which alkylates DNA (cross-links guanine bases), preventing replication/transcription — cell-cycle non-specific

Uses

  • Malignancies: lymphomas, leukaemias, breast cancer, various solid tumours
  • Immunosuppression: nephrotic syndrome, rheumatoid arthritis, SLE, vasculitis
  • Conditioning regimen before bone marrow transplantation

Adverse effects

  • Haemorrhagic cystitis (acrolein metabolite) — prevented with hydration and mesna
  • Myelosuppression
  • Alopecia
  • Gonadal toxicity/infertility
  • SIADH (high doses)

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