Cyclophosphamide (CYP) is an alkylating chemotherapeutic agent that is used in a variety of malignant conditions including lymphomas, ovarian and breast cancer. Hemorrhagic cystitis (HC) is a well known and a potentially life-threatening adverse effect of this drug. The incidence of HC is related to the dosage and may be as high as 75% in patients receiving a high intravenous dose. It has been proposed that urothelial damage occurs by direct contact with acrolein, which causes edema, ulceration, neovascularization, hemorrhage, and necrosis. Adequate hydration and the concurrent administration of sodium-2-mercaptoethane (mesna) are the most widely employed methods for prevention of CYP-induced HC in clinical practice. Concurrent administration of the uroprotective agent Mesna will aid largely in the prevention of bladder toxicity but still some 40% of high-dose cytoxan pateints develop bladder toxicity.
The use of mesna and/or continuous bladder irrigation is rarely needed for doses <2 g/m 2. Cyclophosphamide (Cytoxan, Neosar) is associated with hemorrhagic cystitis in ~10% of patients being treated with standard doses. Incidence may increase to as high as 40% in patients receiving high-dose chemotherapy with bone marrow transplantation (BMT).
Korkmaz A, Oter S, Deveci S, Goksoy C, Bilgic H. Prevention of further cyclophosphamide induced hemorrhagic cystitis by hyperbaric oxygen and mesna in guinea pigs. J Urol 2001;166:1119-23.
AHFS Monograph – http://www.medscape.com/druginfo/monograph?cid=med&drugid=52888&drugname=Cytoxan+IV&monotype=monograph&secid=5
S Cesaro et al, Incidence and treatment of hemorrhagic cystitis in children given hematopoietic stem cell transplantation: a survey from the Italian association of pediatric hematology oncology-bone marrow transplantation group BMT November (1) 2003, Volume 32, Number 9, Pages 925-931
Watson NA, Notley RG. Urologic complications of cyclophos-phamide. Br J Urol 1973; 45: 609-612.