Acute and Long-term Toxicity of Cyclophosphamide

Cyclophosphamid has been widely used in patients with kidney diseases such as vasculitis, SLE, steroid-resistant nephrotic syndrome and also progressive IgA-nephropathy. Beside acute side effects like bone-marrow toxicity, infections, haemorrhagic cystitis, gastrointestinal side effects and hair loss, the main concern is the long-term effect of the drug which may occur years after treatment when patients with end-stage renal disease have received a transplant. Incidences increase for tumours, especially bladder carcinoma, lymphomas and tumours of the skin, for the myelodysülastic syndrome and the permanent infertility. As most of the side effects are associated with the total dose of CP, dose reduction by stage-adapted treatment, i.v. administration, shorter treatment time and prevention of relapses is an important issue. In addition, some side effects may be reduced or even prevented, e.g. bladder toxicity by the use of Mesna, skin tumours by sun blockers, permanent infertility by sperm conservation or by gonadotropin-releasing hormone analogue. In patients with high CP exposure awareness of the increased tumour risk may lead to early detection and the chance or curative treatment.