Cyclophosphamide: High Dose for Stem Cell Transplant (Generic Name)
Other Names: Cytoxan®, Neosar®
About This Drug
Cyclophosphamide is used to treat cancer. It is often included in pre-transplant chemotherapy. In addition to its anti-cancer effects, it also helps to suppress your immune system. Cyclophosphamide can also be used before apheresis to increase the number of stem cells in the peripheral blood. This drug is given in the vein (IV).
Possible Side Effects (More Common)
- Nausea and throwing up (vomiting). These symptoms may happen within a few hours after your treatment and may last up to 72 hours. Medicines are available to stop or lessen these side effects.
- Bone marrow depression. This is a decrease in the number of white blood cells, red blood cells, and platelets. This may raise your risk of infection, make you tired and weak (fatigue), and raise your risk of bleeding.
- Hair loss: You may notice hair getting thin. Some patients lose their hair. Hair loss is often complete scalp hair loss and can involve loss of eyebrows, eyelashes, and pubic hair. You may notice this a few days or weeks after treatment has started. Most often hair loss is temporary; your hair should grow back when treatment is done.
- Decreased appetite (decreased hunger)
- Blurred vision
- Soreness of the mouth and throat. You may have red areas, white patches, or sores that hurt.
- Effects on the bladder. This drug may cause irritation and bleeding in the bladder. You may have blood in your urine. To help stop this, you will get extra fluids to help you pass more urine. You may get a drug called mesna, which helps to decrease irritation and bleeding. You may also get a medicine to help you pass more urine. You may have a catheter (tube) placed in your bladder so that your bladder will be washed with this drug.
- Loose bowel movements (diarrhea) that may last for a few days
Possible Side Effects (Less Common)
- Congestive heart failure. You may be short of breath. Your arms, hands, legs and feet may swell
- Metallic taste in the mouth
- Darkening of the skin or nails
- Changes in lung tissue may happen with large amounts of this drug. These changes may not last forever, and your lung tissue may go back to normal. Sometimes these changes may not be seen for many years. You may get a cough or have trouble catching your breath.
Serious allergic reactions including anaphylaxis are rare. While you are getting this drug in your vein (IV), tell your nurse right away if you have any of these symptoms of an allergic reaction:
- Trouble catching your breath
- Feeling like your tongue or throat are swelling
- Feeling your heart beat quickly or in a not normal way (palpitations)
- Feeling dizzy or lightheaded
- Flushing, itching, rash, and/or hives
Treating Side Effects
- Drink 6-8 cups of fluids each day unless your doctor has told you to limit your fluid intake due to some other health problem. A cup is 8 ounces of fluid. If you throw up or have loose bowel movements you should drink more fluids so that you do not become dehydrated (lack water in the body due to losing too much fluid).
- Ask your doctor or nurse about medicine that is available to help prevent or lessen nausea or throwing up.
- Mouth care is very important. Your mouth care should consist of routine, gentle cleaning of your teeth or dentures and rinsing your mouth with a mixture of 1/2 teaspoon of salt in 8 ounces of water or ½ teaspoon of baking soda in 8 ounces of water. This should be done at least after each meal and at bedtime.
- If you have mouth sores, avoid mouthwash that has alcohol. Also avoid alcohol and smoking because they can bother your mouth and throat.
- Talk with your nurse about getting a wig before you lose your hair. Also, call the American Cancer Society at 800-ACS-2345 to find out information about the “ Look Good...Feel Better” program close to where you live. It is a free program where women undergoing chemotherapy learn about wigs, turbans and scarves as well as makeup techniques and skin and nail care.
Whenever you tell a doctor or nurse your health history, always tell them that you have received cyclophosphamide in the past.
Food and Drug Interactions
There are no known interactions of cyclophosphamide with food. This drug may interact with other medicines. Tell your doctor and pharmacist about all the medicines and dietary supplements (vitamins, minerals, herbs and others) that you are taking at this time. The safety and use of dietary supplements and alternative diets are often not known. Using these might affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor's help.
When to Call the Doctor
Call your doctor or nurse right away if you have any of these symptoms:
- Fever of 100.5 F (38 C) or higher
- Bleeding or bruising that is not usual
- Blurred vision or other changes in eyesight
- Pain when passing urine; blood in urine
- Pain in your lower back or side
- Wheezing or trouble breathing
- Swelling of legs, ankles, or feet
- Feeling dizzy or lightheaded
- Feeling confused or agitated
- Signs of liver problems: dark urine, pale bowel movements, bad stomach pain, feeling very tired and weak, unusual itching, or yellowing of the eyes or skin Unusual thirst or passing urine often
- Nausea that stops you from eating or drinking
- Throwing up more than 3 times a day
- Loose bowel movements (diarrhea) more than 4 times a day or diarrhea with weakness or feeling lightheaded
Call your doctor or nurse as soon as possible if any of these symptoms happen:
- Pain in your mouth or throat that makes it hard to eat or drink
- Nausea not relieved by prescribed medicines
- Heavy menstrual period that lasts longer than normal
Sexual Problems and Reproductive Concerns
- Infertility warning: Sexual problems and reproduction concerns may happen. In both men and women, this drug may affect your ability to have children. This cannot be determined before your treatment. Talk with your doctor or nurse if you plan to have children. Ask for information on sperm or egg banking.
- In men, this drug may interfere with your ability to make sperm, but it should not change your ability to have sexual relations.
- In women, menstrual bleeding may become irregular or stop while you are getting this drug. Do not assume that you cannot become pregnant if you do not have a menstrual period.
- Women may go through signs of menopause (change of life) like vaginal dryness or itching. Vaginal lubricants can be used to lessen vaginal dryness, itching, and pain during sexual relations.
- Genetic counseling is available for you to talk about the effects of this drug therapy on future pregnancies. Also, a genetic counselor can look at the possible risk of problems in the unborn baby due to this medicine if an exposure happens during pregnancy.
- Pregnancy warning: This drug may have harmful effects on the unborn child, so effective methods of birth control should be used during your cancer treatment.
- Breast feeding warning: Women should not breast feed during treatment because this drug could enter the breast milk and badly harm a breast feeding baby.
Revised July 2014