Cyclophosphamide (Cytoxan)

==General information==
Class/mechanism: Alkylating agent; transformed primarily in the liver to active metabolites which alkylate and crosslink DNA.Cyclophosphamide (Cytoxan) package insert Cyclophosphamide (Cytoxan) package insert (locally hosted backup)
Route: IV, PO
Extravasation: irritant or neutral, depending on reference; n/a
For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, UpToDate Lexidrug, Medscape,or the prescribing information.
==Diseases for which it is established (work in progress)==
*Acute lymphoblastic leukemia (FDA)
**B-cell acute lymphoblastic leukemia
*Acute myeloid leukemia (FDA)
*Breast cancer (FDA)
*Chronic lymphocytic leukemia (FDA)
*Chronic myeloid leukemia (FDA)
*Classical Hodgkin lymphoma (FDA)
*Light-chain (AL) amyloidosis (PMDA)
*Multiple myeloma (FDA)
*Neuroblastoma (FDA)
*Non-Hodgkin lymphoma (FDA, PMDA)
**Burkitt lymphoma (FDA)
**Diffuse large B-cell lymphoma (FDA)
**Indolent lymphoma
***Follicular lymphoma
**Mantle cell lymphoma
**Mycosis fungoides (FDA)
**Peripheral T-cell lymphoma
*Pheochromocytoma (PMDA)
==Scenarios for which it is established==
*Cellular therapy conditioning regimens (PMDA)
==Diseases for which it is used==
*Acquired hemophilia A
*Acute lymphoblastic leukemia, infant
*Adult T-cell leukemia-lymphoma
*Anaplastic glioma
*Anaplastic large cell lymphoma
*Bladder cancer
*Castleman disease
*Central nervous system (CNS) cancer
*CNS lymphoma
*Ewing sarcoma
*Gestational trophoblastic neoplasia
*Glioblastoma
*Graft versus host disease
*High-grade B-cell lymphoma
*HIV-associated lymphoma
*Hodgkin lymphoma, nodular lymphocyte-predominant
*Large granular lymphocytic leukemia
*Marginal zone lymphoma
*Mediastinal gray-zone lymphoma
*Medulloblastoma
*Osteosarcoma
*Plasma cell leukemia
*Post-transplant lymphoproliferative disorder
*Primary mediastinal B-cell lymphoma
*Prostate cancer
*Rhabdomyosarcoma
*T-cell acute lymphoblastic leukemia
*Thymoma
*Transformed lymphoma
*Urothelial carcinoma
*Waldenström macroglobulinemia
==Diseases for which it was used==
*Non-small cell lung cancer
*Ovarian cancer (FDA)
*Renal cell carcinoma
*Small cell lung cancer
*Testicular cancer
==Patient drug information==
*Cyclophosphamide (Cytoxan) package insert
*Cyclophosphamide (Cytoxan) patient drug information (Chemocare)Cyclophosphamide (Cytoxan) patient drug information (Chemocare)
*Cyclophosphamide (Cytoxan) patient drug information (UpToDate)Cyclophosphamide (Cytoxan) patient drug information (UpToDate)
==History of changes in FDA indication==
*1959-11-16: initial FDA approval
*2012-03-31 (oldest label available at Drugs @ FDA): Approved for malignant lymphomas (Stages III and IV of the Ann Arbor staging system), Hodgkin’s disease, lymphocytic lymphoma (nodular or diffuse), mixed-cell type lymphoma, histiocytic lymphoma, Burkitt lymphoma; multiple myeloma, leukemias: Chronic lymphocytic leukemia, chronic granulocytic leukemia (it is usually ineffective in acute blastic crisis), acute myelogenous and monocytic leukemia, acute lymphoblastic (stem-cell) leukemia in children (cyclophosphamide given during remission is effective in prolonging its duration); mycosis fungoides (advanced disease); neuroblastoma (disseminated disease); adenocarcinoma of ovary; retinoblastoma; carcinoma of the breast (No supporting studies are cited)
==History of changes in EMA indication==
*1958-10-13: EURD
==History of changes in PMDA indication==
*2013-03-25: New additional indication and a new dosage for the treatment of pheochromocytoma.
*2015-06-26: revised indication and a new dosage for the relief of symptoms of malignant lymphoma.
*2019-03-26: New indication for the treatment prior to tumor-specific T-cell infusion therapy.
*2021-08-21: New indication and a new dosage for the treatment of systemic AL amyloidosis.
==Also known as==
*Code names: B-518, WR-138719
*Generic names: CP monohydrate, CPM, cyclophosphamid monohydrate, cyclophosphamide monohydrate
*Brand names:
Synonyms 	Synonyms 	Synonyms 	Synonyms 	Synonyms 	Synonyms 	Synonyms 	Synonyms
Alkyloxan 	Biodoxan 	Carloxan 	Ciclofosfamida	Ciclokebir 	Cicloxal 	Clafen 	Claphene
Cyclam 	Cycloblastin 	Cycloblastine	CYCLO-cell 	Cycloferon 	Cyclomide 	Cyclophar	Cyclophospham
Cyclophosphamid	Cyclophosphane	Cyclostin 	Cyclostine 	Cyclotox 	Cycloxan 	Cycram 	Cydoxan
Cyklofosfamid 	Cyphos 	Cytophosphan 	Cytoxan 	Cytoxan Lyophilized	Endoxan 	Endoxan-N	Endoxana
Enduxan 	Formitex 	Fosfaseron 	Genoxal 	Genuxal 	Hidrofosmin	Ledoxan 	Ledoxina
Mitoxan 	Neophos 	Neosar 	Oncomide 	Oncophos 	Procytox 	Revimmune	Sendoxan
Siklofos 	Syklofosfamid 	Tymtran 	Zuviphos 	Zycram 	Zytoxan 	 	
==References==
Category:Drugs
Category:Intravenous medications
Category:Oral medications
Category:Irritant
Category:Neutral
Category:Alkylating agents
Category:Nitrogen mustards
Category:Immunosuppressants
Category:Acquired hemophilia A medications
Category:Acute lymphoblastic leukemia, infant medications
Category:Acute myeloid leukemia medications
Category:Adult T-cell leukemia-lymphoma medications
Category:Anaplastic glioma medications
Category:Anaplastic large cell lymphoma medications
Category:B-cell acute lymphoblastic leukemia medications
Category:Bladder cancer medications
Category:Breast cancer medications
Category:Burkitt lymphoma medications
Category:Castleman disease medications
Category:CNS lymphoma medications
Category:Chronic lymphocytic leukemia medications
Category:Chronic myeloid leukemia medications
Category:Classical Hodgkin lymphoma medications
Category:Diffuse large B-cell lymphoma medications
Category:Ewing sarcoma medications
Category:Follicular lymphoma medications
Category:Gestational trophoblastic neoplasia medications
Category:Glioblastoma medications
Category:Graft versus host disease medications
Category:High-grade B-cell lymphoma medications
Category:HIV-associated lymphoma medications
Category:Hodgkin lymphoma, nodular lymphocyte-predominant medications
Category:Indolent lymphoma medications
Category:Large granular lymphocytic leukemia medications
Category:Light-chain (AL) amyloidosis medications
Category:Mantle cell lymphoma medications
Category:Marginal zone lymphoma medications
Category:Mediastinal gray-zone lymphoma medications
Category:Medulloblastoma medications
Category:Multiple myeloma medications
Category:Neuroblastoma medications
Category:Osteosarcoma medications
Category:Peripheral T-cell lymphoma medications
Category:Pheochromocytoma medications
Category:Plasma cell leukemia medications
Category:Post-transplant lymphoproliferative disorder medications
Category:Primary mediastinal B-cell lymphoma medications
Category:Prostate cancer medications
Category:Rhabdomyosarcoma medications
Category:T-cell acute lymphoblastic leukemia medications
Category:Thymoma medications
Category:Transformed lymphoma medications
Category:Urothelial carcinoma medications
Category:Waldenström macroglobulinemia medications
Category:Non-small cell lung cancer medications (historic)
Category:Ovarian cancer medications (historic)
Category:Renal cell carcinoma medications (historic)
Category:Small cell lung cancer medications (historic)
Category:Testicular cancer medications (historic)
Category:FDA approved in 1959
Category:EMA approved in 1958
Category:PMDA approved drugs
Category:WHO Essential Cancer Medicine