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Cyclophosphamide (CP), also known as cytophosphane among other names, [3] is a medication used as chemotherapy and to suppress the immune system. [4] As chemotherapy it is used to treat lymphoma, multiple myeloma, leukemia, ovarian cancer, breast cancer, small cell lung cancer, neuroblastoma, and sarcoma. [4]
Multiple myeloma is the second-most prevalent blood cancer (10%) after non-Hodgkin's lymphoma. [154] It represents about 1.8% of all new cancers and 2.1% of all cancer deaths. [7] Multiple myeloma affects slightly more men than women.
A fundamental philosophy of medical oncology, including combination chemotherapy, is that different drugs work through different mechanisms, and that the results of using multiple drugs will be synergistic to some extent. Because they have different dose-limiting adverse effects, they can be given together at full doses in chemotherapy regimens ...
The term 'hyper' refers to the hyperfractionated nature of the chemotherapy, which is given in smaller doses, more frequently, to minimize side effects. 'CVAD' is the acronym of the drugs used in course A: cyclophosphamide, vincristine, doxorubicin (also known by its trade name, Adriamycin), and dexamethasone.
Diagnosis is typically based on blood tests that find high numbers of mature lymphocytes and smudge cells. [ 5 ] This is an example of how a smudge cell looks on a peripheral blood smear, which is a common finding in patients with chronic lymphocytic leukemia (CLL).
However, it did not show more effectiveness than standard-dose [R]-CHOEP while adding more toxicity and cost. [8] In order to try improving efficacy of the [R]-CHOEP, some researchers tried to escalate chemotherapy to very high doses, requiring autologous stem cell support in each cycle. Doses in that regimen were increased from cycle to cycle.
In conventional chemotherapy, a dose close to the maximum tolerated dose is administered in a bolus manner to achieve cytotoxic effects on tumor cells. [5] However, the side effects are often significant as the cytotoxic agents also kill the fast-dividing cells normally present in the body, such as bone marrow cells and epithelial cells of the gastrointestinal tract. [6]
In 1983, Coates et al. found that patients receiving chemotherapy ranked nausea and vomiting as the first and second most severe side effects, respectively. Up to 20% of patients receiving highly emetogenic agents in this era postponed, or even refused, potentially curative treatments. [ 1 ]
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