Obesity effects on cyclophosphamide-induced DNA damage in hematopoietic cell transplant recipients.

BACKGROUND Cyclophosphamide, an alkylating agent, is metabolically activated to phosphoramide mustard, to form toxic DNA-DNA (G-NOR-G) crosslinks. Increased exposure to cyclophosphamide metabolites has been associated with treatment-related toxicity. The effect of obesity on exposure to cyclophosphamide-induced G-NOR-G crosslinks is not known. Therefore we sought to determine whether obesity affects the formation of cyclophosphamide-specific G-NOR-G crosslinks. PATIENTS AND METHODS Plasma cyclophosphamide concentrations and blood cell G-NOR-G amounts were measured. RESULTS Overweight/obese patients received a significantly higher daily cyclophosphamide dose (median 3000 vs. 4450 mg, p<0.01). Despite the higher doses, overweight/obese patients had lower exposure to cyclophosphamide compared to lean patients with an area under the curve (AUC(0-∞)) =529.24 vs. 867.99 μcg/ml*h respectively, p<0.01. G-NOR-G amounts were similar in overweight/obese and lean subjects, AUC(0-∞)=142.8 vs. 147.0 adducts/10(6) nucleotides*h, respectively, p=0.59. CONCLUSION Overweight/obese patients have altered metabolism and disposition of cyclophosphamide. This altered exposure may be an important determinant of efficacy and may play a role in treatment-related mortality.