Cyclophosphamide is a synthetic alkylating agent chemically related to the nitrogen mustards with antineoplastic and immunosuppressive activities.
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Cyclofosphamide is a potent immunosuppressive agent and the most commonly used drug in blood and marrow transplantation. Cyclophosphamide's unique metabolism and inactivation by aldehyde dehydrogenase is responsible for its distinct cytotoxic properties[3]. High-dose chemotherapy and continuous daily oral regimens are associated with significant toxicity profiles, but i.v. pulsed regimens have lowered the rates of adverse effects in rheumatological studies[4]. In haploidentical hematopoietic stem cell transplants, post-transplant cyclophosphamide together with standard prophylaxis reduces the incidence of GVHD (graft-versus-host disease) to acceptable rates without the need for T cell depletion[5]. Moreover, using in vitro rodent embryo culture has demonstrated that Cyclofosphamide must be bioactivated to be teratogenic[6]. High-dose cyclophosphamide (200 mg/kg) can as a conditioning regimen for allogeneic bone marrow transplantation. High-dose cyclophosphamide is maximally immunosuppressive, but not myeloablative. Early hematopoietic stem cells are spared the cytotoxicity of cyclophosphamide because of their high levels of aldehyde dehydrogenase, an enzyme that confers resistance to the drug[7].
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