Cyclophosphamide Accord

Alkylating agent for cancer treatment and immunosuppression

Rx – Prescription Only ATC: L01AA01 Alkylating Agent
Active Ingredient
Cyclophosphamide
Available Forms
Solution for injection/infusion
Strengths
200 mg/ml
Brand Names
Cyclophosphamide Accord, Cytoxan, Endoxan
✓ Medically reviewed

Cyclophosphamide Accord is a powerful alkylating chemotherapy agent used to treat a wide range of cancers and severe autoimmune diseases. Administered intravenously as a 200 mg/ml concentrated solution, it works by forming cross-links in DNA that prevent cancer cells from dividing and growing. This medication must only be prescribed and monitored by physicians experienced in cytotoxic chemotherapy, as it carries significant risks including bone marrow suppression and hemorrhagic cystitis. It is listed on the WHO Model List of Essential Medicines, reflecting its critical importance in cancer treatment worldwide.

Published:
Last reviewed:
Evidence Level 1A

Quick Facts

Active Ingredient
Cyclophosphamide
Drug Class
Alkylating Agent
ATC Code
L01AA01
Common Uses
Cancer & Autoimmune
Available Forms
IV Solution
Prescription Status
Rx Only

Key Takeaways

  • Cyclophosphamide Accord is an essential chemotherapy drug used for lymphomas, leukemias, breast cancer, and severe autoimmune diseases such as lupus nephritis and vasculitis.
  • It is a prodrug that must be activated by liver enzymes, forming metabolites that cross-link DNA strands and kill rapidly dividing cells.
  • Regular blood count monitoring is mandatory due to the risk of severe bone marrow suppression, with the nadir typically occurring 7 to 14 days after administration.
  • Adequate hydration (at least 2–3 liters per day) and mesna co-administration are critical to prevent hemorrhagic cystitis, a characteristic and potentially serious side effect.
  • Cyclophosphamide can cause infertility; fertility preservation should be discussed with all patients of reproductive age before treatment begins.

What Is Cyclophosphamide Accord and What Is It Used For?

Cyclophosphamide Accord is an alkylating chemotherapy agent belonging to the nitrogen mustard family. It is one of the most widely used anticancer drugs in the world and is included on the WHO Model List of Essential Medicines. It treats various cancers and severe autoimmune conditions by disrupting DNA replication in rapidly dividing cells.

Cyclophosphamide was first synthesized in the late 1950s and received FDA approval in 1959. It was developed as a targeted derivative of nitrogen mustard, designed to be selectively activated in tumor tissue. Although this original concept of selective activation was not entirely realized, cyclophosphamide proved to be remarkably effective against a broad spectrum of malignancies and has remained a cornerstone of cancer treatment for over six decades.

As a prodrug, cyclophosphamide itself is pharmacologically inactive. After intravenous administration, it is transported to the liver where cytochrome P450 enzymes (primarily CYP2B6, CYP3A4, and CYP2C9) convert it into its active metabolites: 4-hydroxycyclophosphamide and aldophosphamide. These compounds spontaneously decompose into phosphoramide mustard, which forms the critical DNA cross-links, and acrolein, a byproduct responsible for bladder toxicity.

The mechanism of action involves the formation of both interstrand and intrastrand DNA cross-links. Phosphoramide mustard alkylates the N7 position of guanine bases in DNA, creating covalent bonds between the two strands of the double helix. This prevents the DNA from being unwound and replicated during cell division, ultimately triggering programmed cell death (apoptosis). Because cancer cells typically divide more rapidly than normal cells, they are disproportionately affected, though the drug does also affect healthy rapidly dividing cells such as those in the bone marrow, hair follicles, and gastrointestinal lining.

In addition to its cytotoxic properties, cyclophosphamide has significant immunosuppressive effects. At lower doses, it preferentially depletes B lymphocytes and regulatory T cells, which makes it useful for treating severe autoimmune conditions where the immune system attacks the body's own tissues.

Oncology Indications

Cyclophosphamide is used in numerous chemotherapy regimens for a wide variety of cancers. Its versatility is one of the reasons it has remained indispensable in oncology:

  • Non-Hodgkin lymphoma (NHL) – a key component of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and R-CHOP regimens
  • Hodgkin lymphoma – used in BEACOPP and other combination regimens
  • Chronic lymphocytic leukemia (CLL) – part of FC (fludarabine-cyclophosphamide) and FCR protocols
  • Acute lymphoblastic leukemia (ALL) – incorporated into induction and consolidation regimens
  • Breast cancer – essential component of AC (doxorubicin-cyclophosphamide), CMF, FEC, and TAC regimens
  • Ovarian cancer – historically used in combination with platinum agents
  • Small cell lung cancer (SCLC) – used in various combination regimens
  • Multiple myeloma – part of several treatment protocols including VCD
  • Neuroblastoma and other pediatric cancers – widely used in pediatric oncology
  • Bone marrow transplant conditioning – high-dose cyclophosphamide is a standard component of myeloablative conditioning regimens before stem cell transplantation

Autoimmune and Rheumatologic Indications

Beyond oncology, cyclophosphamide plays a critical role in managing severe, life-threatening autoimmune and inflammatory conditions:

  • Lupus nephritis – particularly Class III and IV (proliferative) lupus nephritis, where it helps preserve kidney function
  • ANCA-associated vasculitis – including granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA)
  • Severe systemic sclerosis – for progressive interstitial lung disease
  • Refractory autoimmune hemolytic anemia
  • Severe pemphigus and pemphigoid

What Should You Know Before Taking Cyclophosphamide Accord?

Before starting cyclophosphamide treatment, your healthcare team will conduct comprehensive assessments including complete blood counts, kidney and liver function tests, urinalysis, cardiac evaluation, and fertility counseling. Understanding the contraindications, warnings, and precautions is essential for safe treatment.

Cyclophosphamide is a potent medication with a narrow therapeutic index, meaning the difference between an effective dose and a toxic dose is relatively small. For this reason, it must only be prescribed by physicians experienced in the use of cytotoxic chemotherapy, and patients must be closely monitored throughout treatment. Before initiating therapy, a thorough medical evaluation is necessary to identify any factors that could increase the risk of serious adverse effects.

Contraindications

Cyclophosphamide Accord must not be used in the following situations:

  • Hypersensitivity to cyclophosphamide or any of its excipients
  • Severe bone marrow suppression – pre-existing severe myelosuppression, particularly in patients who have been heavily pretreated with cytotoxic agents or radiation therapy
  • Active urinary tract infections or acute hemorrhagic cystitis
  • Urinary outflow obstruction – conditions that prevent adequate bladder emptying increase the risk of cystitis
  • Active infections – severe ongoing infections should be treated before starting cyclophosphamide
  • Pregnancy and breastfeeding – cyclophosphamide is teratogenic (Category D) and is excreted in breast milk

Warnings and Precautions

The following precautions must be carefully observed during cyclophosphamide therapy:

  • Myelosuppression – Regular complete blood count (CBC) monitoring is mandatory. The white blood cell count typically reaches its nadir 7–14 days after a dose and recovers by days 21–28. Treatment may need to be delayed or doses reduced if counts are too low.
  • Hemorrhagic cystitis – Adequate hydration is essential. Patients should drink at least 2–3 liters of fluid daily and void frequently. Mesna (sodium 2-mercaptoethane sulfonate) should be administered with higher doses to bind acrolein in the urinary tract.
  • Cardiotoxicity – High doses (particularly above 150 mg/kg or above 1.5 g/m2/day over 4 days) can cause acute cardiac toxicity including hemorrhagic myocarditis. Cardiac function should be monitored, especially in patients with pre-existing cardiac disease or those receiving other cardiotoxic agents.
  • Pulmonary toxicity – Interstitial pneumonitis and pulmonary fibrosis have been reported, particularly with prolonged use or high cumulative doses.
  • Hepatotoxicity – Liver function should be monitored. Veno-occlusive disease (sinusoidal obstruction syndrome) can occur, particularly in the transplant setting.
  • Secondary malignancies – Cyclophosphamide is itself carcinogenic. There is an increased risk of secondary cancers, particularly bladder cancer, myelodysplastic syndrome (MDS), and acute myeloid leukemia (AML), especially with prolonged use.
  • Infections – Immunosuppression increases susceptibility to bacterial, viral, fungal, and protozoal infections. Live vaccines must be avoided during and for a period after treatment.
  • Wound healing – Cyclophosphamide may interfere with normal wound healing. Surgical procedures should be planned carefully in relation to treatment cycles.

Pregnancy and Breastfeeding

Cyclophosphamide crosses the placenta and can cause severe birth defects, particularly when administered during the first trimester. Abnormalities reported include limb malformations, facial abnormalities, and central nervous system defects. If pregnancy occurs during treatment, the patient must be informed of the potential risks to the fetus, and specialist counseling should be provided.

Cyclophosphamide and its metabolites are excreted into breast milk. Breastfeeding is absolutely contraindicated during treatment and should not be resumed until advised by the treating physician, as metabolites may persist for some time after discontinuation.

How Does Cyclophosphamide Accord Interact with Other Drugs?

Cyclophosphamide has numerous clinically significant drug interactions because it is both a substrate and an inducer of cytochrome P450 enzymes. Its activation and metabolism can be altered by CYP450 inducers and inhibitors, potentially increasing toxicity or reducing efficacy. Always inform your healthcare team about all medications, supplements, and herbal products you are taking.

Because cyclophosphamide requires hepatic activation via CYP450 enzymes (primarily CYP2B6 and CYP3A4), any drug that induces or inhibits these enzymes can significantly affect the levels of active metabolites. CYP450 inducers may increase the production of toxic metabolites, potentially worsening side effects, while CYP450 inhibitors may reduce efficacy by decreasing metabolite formation. The complexity of these interactions underscores the importance of comprehensive medication review before and during cyclophosphamide therapy.

Major Interactions

Major Drug Interactions Requiring Dose Adjustment or Avoidance
Interacting Drug Effect Clinical Significance
Allopurinol Increased bone marrow suppression Monitor blood counts closely; dose reduction may be needed
Phenobarbital / Phenytoin CYP450 induction increases toxic metabolite production Higher risk of toxicity; consider alternative anticonvulsants
Warfarin Both increased and decreased anticoagulant effect reported Monitor INR frequently and adjust warfarin dose
Doxorubicin / Anthracyclines Additive cardiotoxicity and myelosuppression Monitor cardiac function; cumulative dose limits apply
Succinylcholine Prolonged neuromuscular blockade (cyclophosphamide inhibits pseudocholinesterase) Inform anesthesiologist; avoid if possible or use reduced doses
Live vaccines Risk of disseminated vaccine infection Contraindicated during and for 3–6 months after treatment
Ciclosporin / Tacrolimus Reduced ciclosporin levels; increased immunosuppression Monitor drug levels and immune status closely

Minor Interactions

Minor Drug Interactions Requiring Monitoring
Interacting Drug Effect Clinical Significance
Thiazide diuretics May potentiate myelosuppressive effects Monitor blood counts; consider alternative diuretics
ACE inhibitors Potential for increased leukopenia Monitor white blood cell counts
Grapefruit juice CYP3A4 inhibition may reduce activation of cyclophosphamide Avoid large quantities; clinical significance uncertain
St. John's Wort CYP3A4 induction may increase toxic metabolite formation Avoid concomitant use
Metformin Potential for lactic acidosis in patients with renal impairment Monitor renal function; temporary discontinuation may be needed
Note for Healthcare Professionals

This is not a complete list of drug interactions. Cyclophosphamide metabolism involves multiple CYP450 pathways, making interactions complex and sometimes unpredictable. Always consult the complete Summary of Product Characteristics (SmPC) or FDA prescribing information and use clinical drug interaction databases when planning treatment regimens.

What Is the Correct Dosage of Cyclophosphamide Accord?

Cyclophosphamide dosing is highly individualized based on the specific cancer or condition being treated, the patient's body surface area (BSA) or weight, kidney and liver function, blood counts, and the overall treatment protocol. Doses range from approximately 500 mg/m2 for immunosuppressive use to over 60 mg/kg for transplant conditioning regimens. Only a qualified oncologist or specialist should determine the appropriate dose.

Cyclophosphamide Accord 200 mg/ml is a concentrated solution that must be diluted before intravenous administration. The solution should be diluted with 0.9% sodium chloride (normal saline) or 5% glucose solution to the required concentration. The specific dilution and infusion rate depend on the dose and protocol being used. All preparation should be carried out by trained personnel using appropriate protective equipment and in accordance with local guidelines for handling cytotoxic drugs.

Adults

Adult dosing varies enormously depending on the indication and treatment protocol:

Oncology – Combination Chemotherapy

Typical doses range from 500–1,500 mg/m2 per cycle, given as a single intravenous infusion every 2–4 weeks. The exact dose depends on the specific regimen. For example, in the CHOP regimen for lymphoma, the standard cyclophosphamide dose is 750 mg/m2 on day 1 of each 21-day cycle.

Oncology – High-Dose / Transplant Conditioning

For stem cell transplant conditioning, doses may reach 50–60 mg/kg/day for 2–4 consecutive days, representing total cumulative doses of 120–200 mg/kg. These high-dose regimens require intensive supportive care including mesna prophylaxis, vigorous hydration, and close monitoring of cardiac function.

Autoimmune Conditions

For lupus nephritis and vasculitis, the typical dose is 500–1,000 mg/m2 given as a pulse intravenous infusion, usually monthly for 6 months (induction phase), followed by less frequent administration. The Euro-Lupus regimen uses lower fixed doses of 500 mg every 2 weeks for 6 doses, which has shown comparable efficacy with reduced toxicity.

Children

Cyclophosphamide is used in various pediatric oncology protocols. Dosing is calculated based on body surface area (mg/m2) or body weight (mg/kg) according to the specific protocol. Children generally tolerate cyclophosphamide differently from adults – they may have higher clearance rates but are also more susceptible to certain long-term effects including growth impairment and gonadal toxicity. Pediatric dosing must always follow established treatment protocols under the guidance of a pediatric oncologist.

Elderly

Elderly patients may have reduced renal and hepatic function, which can affect cyclophosphamide metabolism and clearance. Dose adjustments may be necessary based on creatinine clearance and liver function. Elderly patients are also more susceptible to cardiotoxicity and myelosuppression. The treating physician should carefully weigh the benefits against the increased risks and consider starting with lower doses where appropriate.

Dose Adjustments

Dose modifications are frequently required based on:

  • Renal impairment – Dose reduction is recommended when creatinine clearance falls below 10 ml/min. For moderate impairment (CrCl 10–50 ml/min), a 25% dose reduction may be considered.
  • Hepatic impairment – Since cyclophosphamide requires hepatic activation, severe liver dysfunction may paradoxically reduce both efficacy and toxicity. However, the impaired metabolism of toxic byproducts may also increase certain risks. Dose adjustments should be made cautiously.
  • Myelosuppression – If the white blood cell count falls below 3,000/mm3 or platelets below 100,000/mm3, the dose should be reduced or treatment delayed until counts recover.

Missed Dose

Since cyclophosphamide is administered in a clinical setting by healthcare professionals, missed doses are rare but can occur if treatment is postponed due to adverse effects or logistical reasons. If a scheduled dose is missed, the treating physician will determine the appropriate timing for the next dose based on the patient's clinical status and blood counts. Patients should not attempt to adjust their treatment schedule independently.

Overdose

What Are the Side Effects of Cyclophosphamide Accord?

Cyclophosphamide causes numerous side effects that range from very common (affecting more than 1 in 10 patients) to rare. The most clinically significant include bone marrow suppression, hemorrhagic cystitis, nausea/vomiting, hair loss, and infertility. The severity of side effects is generally dose-dependent and increases with cumulative exposure. Early recognition and management of side effects is essential to optimize treatment outcomes.

Like all cytotoxic chemotherapy agents, cyclophosphamide causes side effects because it affects normal rapidly dividing cells in addition to cancer cells. The bone marrow, gastrointestinal tract, hair follicles, and gonads are particularly vulnerable. Many acute side effects are manageable with supportive care and resolve after treatment completion, but some long-term effects may be permanent. Understanding the full spectrum of potential side effects enables patients and healthcare providers to recognize problems early and take appropriate action.

Very Common

Affects more than 1 in 10 patients (>10%)

  • Bone marrow suppression – leukopenia (low white blood cells), neutropenia, thrombocytopenia (low platelets), anemia
  • Nausea and vomiting – cyclophosphamide is classified as moderately to highly emetogenic; antiemetic prophylaxis is standard
  • Alopecia (hair loss) – occurs in up to 80% of patients; usually reversible after treatment discontinuation
  • Immunosuppression – increased susceptibility to infections due to lymphocyte depletion
  • Loss of appetite (anorexia)
  • Amenorrhea – cessation of menstrual periods in women, which may be temporary or permanent
  • Oligospermia / Azoospermia – reduced or absent sperm production in men

Common

Affects 1 to 10 in 100 patients (1–10%)

  • Hemorrhagic cystitis – bladder inflammation with bleeding, caused by the metabolite acrolein
  • Mucositis / Stomatitis – mouth sores and oral inflammation
  • Diarrhea
  • Fatigue and malaise
  • Fever – may be related to infection or drug effect
  • Skin rash and pigmentation changes
  • Liver enzyme elevations
  • Abdominal pain

Uncommon

Affects 1 to 10 in 1,000 patients (0.1–1%)

  • Cardiotoxicity – arrhythmias, heart failure, hemorrhagic myocarditis (mainly with high doses)
  • Pulmonary toxicity – interstitial pneumonitis, pulmonary fibrosis
  • Hepatic veno-occlusive disease (sinusoidal obstruction syndrome)
  • SIADH (syndrome of inappropriate antidiuretic hormone secretion) – causing hyponatremia
  • Severe allergic reactions
  • Peripheral neuropathy

Rare

Affects fewer than 1 in 1,000 patients (<0.1%)

  • Secondary malignancies – bladder cancer, myelodysplastic syndrome (MDS), acute myeloid leukemia (AML)
  • Toxic epidermal necrolysis (TEN) / Stevens-Johnson syndrome
  • Renal tubular necrosis
  • Disseminated intravascular coagulation (DIC)
  • Severe hepatotoxicity including hepatic failure
  • Rhabdomyolysis
  • Bladder fibrosis / contracted bladder (with chronic exposure)
When to Contact Your Healthcare Team

Contact your doctor or nurse immediately if you experience: fever above 38°C (100.4°F), blood in the urine, signs of infection (sore throat, cough, painful urination), unusual bleeding or bruising, severe shortness of breath, persistent vomiting despite antiemetic medication, or chest pain. These symptoms may indicate serious complications requiring urgent medical attention.

How Should You Store Cyclophosphamide Accord?

Cyclophosphamide Accord 200 mg/ml solution should be stored at or below 25°C (77°F) in its original packaging to protect from light. Do not freeze. Once diluted for infusion, the solution should be used within the timeframe specified by the manufacturer, typically within 24 hours when stored at 2–8°C (36–46°F).

As a cytotoxic medication, cyclophosphamide requires special handling and storage precautions. In clinical settings, it is typically stored in pharmacy or ward-based cytotoxic drug storage areas with appropriate access controls and spill management materials available. The medication should be kept in its original packaging until the time of use, as this provides protection from light which can degrade the active substance.

After dilution, the chemical and physical stability of the prepared infusion solution depends on the diluent used and the storage conditions. In general, diluted solutions should be used as soon as practicable after preparation. From a microbiological standpoint, the product should be used immediately unless the method of dilution precludes microbiological contamination risk. If not used immediately, in-use storage times and conditions are the responsibility of the user.

Disposal: Any unused product or waste material should be disposed of in accordance with local requirements for cytotoxic waste. Cyclophosphamide must never be disposed of via household waste or wastewater. Cytotoxic waste containers should be used, and spills must be handled using appropriate cytotoxic spill kits by trained personnel wearing protective equipment.

Keep all medicines out of the sight and reach of children. Do not use this medicine after the expiry date stated on the vial label and outer carton.

What Does Cyclophosphamide Accord Contain?

Each milliliter of Cyclophosphamide Accord solution contains 200 mg of cyclophosphamide as the active substance. The solution also contains excipients necessary for product stability and compatibility with intravenous administration.

Cyclophosphamide (chemical name: 2-[bis(2-chloroethyl)amino]tetrahydro-2H-1,3,2-oxazaphosphorine 2-oxide monohydrate) is a synthetic alkylating agent of the nitrogen mustard group. It is a white crystalline powder with a molecular weight of 279.1 g/mol (monohydrate form). The molecular formula is C7H15Cl2N2O2P·H2O.

The Cyclophosphamide Accord 200 mg/ml formulation is a concentrated solution for injection or infusion. Before administration, it must be diluted with a suitable intravenous diluent (0.9% sodium chloride solution or 5% glucose solution) to achieve the desired concentration for infusion.

Note About Excipients

The complete list of excipients can be found in the Summary of Product Characteristics (SmPC) available from your national medicines regulatory authority (e.g., EMA in Europe, FDA in the United States). If you have known allergies to any pharmaceutical excipients, discuss this with your pharmacist or doctor before treatment.

Frequently Asked Questions About Cyclophosphamide Accord

Cyclophosphamide Accord is used to treat a wide range of cancers including non-Hodgkin lymphoma, Hodgkin lymphoma, chronic lymphocytic leukemia, acute lymphoblastic leukemia, breast cancer, ovarian cancer, small cell lung cancer, and multiple myeloma. It is also a key component of bone marrow transplant conditioning regimens. Beyond oncology, it is used for severe autoimmune conditions such as lupus nephritis, ANCA-associated vasculitis, and severe systemic sclerosis.

The most common side effects (affecting more than 1 in 10 patients) include bone marrow suppression leading to low blood counts, nausea and vomiting, hair loss, immunosuppression with increased infection risk, loss of appetite, and effects on fertility including amenorrhea in women and reduced sperm production in men. Many of these side effects are manageable with supportive care and are reversible after treatment completion, although fertility effects may be permanent, particularly with higher cumulative doses.

Adequate hydration is crucial because cyclophosphamide produces a toxic metabolite called acrolein, which is excreted through the kidneys and can severely damage the bladder lining, causing hemorrhagic cystitis (bladder inflammation with bleeding). Drinking at least 2–3 liters of fluid daily and urinating frequently helps flush acrolein from the bladder before it causes damage. In high-dose regimens, a drug called mesna is also given intravenously to chemically neutralize acrolein in the urinary tract.

Yes, cyclophosphamide can significantly affect fertility in both men and women. In men, it can cause temporary or permanent oligospermia (low sperm count) or azoospermia (complete absence of sperm). In women, it can cause premature ovarian failure, leading to early menopause and infertility. The risk is closely related to the cumulative dose and the patient's age at the time of treatment. Fertility preservation measures such as sperm banking, egg freezing, or ovarian tissue cryopreservation should be discussed with all patients of reproductive age before starting treatment.

Yes, Cyclophosphamide Accord, Cytoxan, and Endoxan all contain the same active ingredient: cyclophosphamide. They are different brand names manufactured by different pharmaceutical companies. While the active substance is identical, the formulations may differ slightly in terms of excipients, concentrations, and available dosage forms. Cyclophosphamide Accord is a 200 mg/ml concentrated solution for injection/infusion, while other brands may be available as powder for reconstitution or in different concentrations. Your healthcare team will select the appropriate formulation for your treatment.

The duration of a cyclophosphamide infusion varies depending on the dose and the specific treatment protocol. Standard-dose infusions typically take 30 minutes to 2 hours. High-dose infusions used in transplant conditioning may be given over 1 to 2 hours per dose, with doses repeated over several consecutive days. The infusion time also depends on the volume of diluted solution and the patient's tolerance. Your healthcare team will determine the appropriate infusion rate for your specific treatment plan. Pre-hydration and post-hydration fluids may add additional time to each treatment session.

References

This article is based on the following peer-reviewed sources and authoritative medical guidelines:

  1. World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List (2023). Geneva: WHO; 2023. Cyclophosphamide is listed as an essential antineoplastic agent.
  2. European Medicines Agency (EMA). Cyclophosphamide – Summary of Product Characteristics. European public assessment reports. EMA; 2024.
  3. U.S. Food and Drug Administration (FDA). Cyclophosphamide – FDA Prescribing Information. Drugs@FDA. Updated 2024.
  4. British National Formulary (BNF). Cyclophosphamide. National Institute for Health and Care Excellence (NICE). BNF 87; 2024.
  5. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: B-Cell Lymphomas, Breast Cancer, and other relevant guidelines. NCCN; 2025.
  6. Emadi A, Jones RJ, Brodsky RA. Cyclophosphamide and cancer: golden anniversary. Nature Reviews Clinical Oncology. 2009;6(11):638–647. doi:10.1038/nrclinonc.2009.146
  7. Houssiau FA, Vasconcelos C, D'Cruz D, et al. Immunosuppressive therapy in lupus nephritis: the Euro-Lupus Nephritis Trial. Arthritis & Rheumatism. 2002;46(8):2121–2131. doi:10.1002/art.10461
  8. de Groot K, Harper L, Jayne DR, et al. Pulse versus daily oral cyclophosphamide for induction of remission in antineutrophil cytoplasmic antibody–associated vasculitis (CYCLOPS). Annals of Internal Medicine. 2009;150(10):670–680. doi:10.7326/0003-4819-150-10-200905190-00004
  9. Bernatsky S, Clarke AE, Suissa S. Hematologic malignant neoplasms after drug exposure in rheumatoid arthritis. Archives of Internal Medicine. 2008;168(4):378–381. doi:10.1001/archinternmed.2007.107
  10. Loren AW, Mangu PB, Beck LN, et al. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. Journal of Clinical Oncology. 2013;31(19):2500–2510. doi:10.1200/JCO.2013.49.2678

Editorial Team

This article has been written and reviewed by the iMedic Medical Editorial Team, consisting of licensed physicians with expertise in oncology, clinical pharmacology, and evidence-based medicine. Our editorial process follows the GRADE framework for evaluating the quality of evidence and strength of recommendations.

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Prepared by medical writers with specialist knowledge of oncology pharmacology and chemotherapy regimens. All content is based on current SmPC data, international guidelines (WHO, EMA, FDA, NCCN, BNF), and peer-reviewed research.

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Reviewed by the iMedic Medical Review Board to ensure clinical accuracy, completeness, and adherence to current treatment guidelines. Our reviewers have no conflicts of interest with pharmaceutical companies.

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