Cyclophosphamide

Also Known As: Cytoxan®, Neosar®, CTX

Class: Alkylating agent

Late Effect (1st of 3)

• Decreased functioning of the ovaries in females or testes in males (hypogonadism)
• Infertility
• Early menopause

Your risk is greater if:

• You are male.
• You are female and were treated during or after puberty.
• It was combined with:
  -Other alkylating agents
  -Radiation therapy to the testicles, pelvis, or total body
• You received a high dose of the drug.

Recommended Evaluation

• History and physical exam, especially sexual history in males and menstrual history in females yearly
• Hormone levels (females - FSH, LH, estradiol; males - LH, FSH, testosterone), and semen analysis as indicated based on need

Management

• Because of the risk of early menopause, females should carefully weigh a decision to delay childbearing.
• You may need a referral to a reproductive endocrinologist for fertility concerns. Sometimes, recovery of fertility occurs spontaneously many years after treatment.
• Your doctor may recommend a bone mineral density to see if you have osteopenia or osteoporosis.
• You may benefit from hormone replacement therapy; discuss it with your doctor.

Late Effect (2nd of 3)

Acute myeloid leukemia (AML)

Your risk is greater if:

• It has been less than 10 years since you finished treatment. (It is more common in first 10 years.)
• You received a cumulative dose of 50 gm or if you also received other alkylating agents, especially melphalan or mechlorethamine.

Recommended Evaluation

• Physical exam yearly
• Complete blood count and differential yearly for up to 15 years
• Evaluation of symptoms of fatigue, pallor, petechiae (small red rash), and bone pain
• A bone marrow exam if you develop any symptoms

Management

• You will be referred to a medical or pediatric oncologist for treatment if you are diagnosed with AML.

Late Effect (3rd of 3)

• Bleeding from an inflamed bladder (might be microscopic only)
• Dysfunctional voiding (inability to empty the bladder completely)

Your risk is greater if:

• You also received pelvic radiation.
• You received a dose of 3 gm/m² or greater.
• You drink alcoholic beverages.
• You use tobacco.

Recommended Evaluation

• Urinalysis yearly
• Evaluation of painful urination or blood in the urine

Management

• You may need a urology consultation.