#cyclophosphamide

Cyclophosphamide

The Scientific Research notes of S. Sunkavally. Years: 1986 - 1990.

The journey through cancer treatment is an odyssey, marked by highs and lows, hope, and challenges. In my own expedition, Cytoxan, or Cyclophosphamide, stands as a stalwart companion in the relentless fight against cancer. This comprehensive exploration delves into the intricate aspects of Cytoxan, unraveling the dosage considerations, potential side effects, and the indomitable spirit required to triumph over cancer.

Understanding Cytoxan (Cyclophosphamide):

Mechanism of Action:

At the crux of Cytoxan's potency lies its distinctive mechanism of action. Operating as an alkylating agent, it disrupts the DNA replication process within cancer cells, thwarting their ability to proliferate. This targeted assault forms the bedrock of its effectiveness across various cancer types.

Indications and Dosage:

Cytoxan is a versatile player in the oncology landscape, utilized in the treatment of diverse cancers, including breast cancer, ovarian cancer, leukemia, and lymphomas. Its dosage is not a one-size-fits-all paradigm, but a nuanced calculation influenced by factors such as the patient's weight, overall health, and the specific cancer type.

Intravenous Administration: The intravenous route is a common avenue for administering Cytoxan. The dosage is structured in cycles, with the frequency and duration dictated by the intricacies of the prescribed treatment protocol.

Oral Administration: In certain instances, Cytoxan is prescribed in oral form, demanding strict adherence to the prescribed dosage and schedule. This flexibility enhances patient convenience while maintaining the efficacy of the treatment.

Personalization of Dosage: The tailoring of the dosage is a meticulous process undertaken by the healthcare team, emphasizing the importance of collaborative decision-making. Regular consultations and open communication ensure that the dosage aligns with the patient's unique circumstances and response to the treatment.

Exploring the Side Effects of Cyclophosphamide:

Common Side Effects:

Like many formidable weapons against cancer, Cytoxan is not without its collateral effects. Nausea, fatigue, and hair loss are frequent companions on this arduous journey. Recognizing these side effects as transient and manageable is pivotal in mentally preparing for and navigating through the challenges they present.

Risk of Infection:

A notable side effect of Cytoxan is its potential to suppress the immune system, heightening susceptibility to infections. Vigilance in maintaining stringent hygiene practices and promptly reporting any signs of infection to healthcare providers becomes a cornerstone in managing this particular challenge.

Gastrointestinal Issues:

Gastrointestinal disturbances, including nausea, vomiting, and diarrhea, may manifest. Proactive measures such as the use of anti-nausea medications and dietary adjustments contribute to alleviating these symptoms, fostering a better tolerance of the treatment.

Long-term Considerations:

The impact of Cytoxan extends beyond the immediate horizon, with long-term effects posing additional considerations. These may include an elevated risk of secondary cancers or infertility. Transparent and ongoing communication with healthcare professionals regarding these concerns becomes indispensable for making informed decisions and tailoring a care plan that aligns with the patient's goals and values.

Empowering Patients:

Educational Resources:

Knowledge is a potent tool in the hands of patients navigating the labyrinth of cancer treatment. Educational resources provided by healthcare professionals and reputable sources empower patients to actively participate in decisions regarding their care. Understanding the intricacies of Cytoxan fosters a sense of control and confidence in the face of uncertainty.

Open Communication:

Establishing clear and open channels of communication with the healthcare team is paramount in fostering a collaborative approach to treatment. Patients must feel empowered to share their concerns, experiences, and any side effects they may be encountering. This dialogue ensures a personalized and supportive care plan, acknowledging the unique circumstances and needs of each individual.

Conclusion:

Hello everyone! I wanted to share my personal journey with you all, particularly my experience with Cyclophosphamide, also known as Cytoxan. Cancer is a battle, and I believe that sharing our stories can be a source of strength and inspiration for others facing similar challenges. In this forum submission, I aim to provide an in-depth user perspective on the process of obtaining and using Cyclophosphamide, how it has affected my life, and the hope it has brought me in my fight against cancer.

Discovering Cyclophosphamide :

When initially diagnosed with cancer, I was confronted with the daunting task of finding the right treatment. Through my research and discussions with healthcare professionals, I came across Cyclophosphamide, a chemotherapy medication used to treat multiple types of cancer. I was drawn to its proven track record and success stories from other patients. After seeking advice from my oncologist, I made the decision to include Cyclophosphamide in my treatment plan, and it has been a crucial component ever since.

Procuring Cyclophosphamide online :

Procuring Cyclophosphamide online can be a challenging and overwhelming process. However, with the right information and guidance, it can become more manageable. I focused my research on reputable online pharmacies and verified their credentials to ensure the authenticity and quality of the medication. It is important to note that purchasing medication online should always be done under the guidance and prescription of a healthcare professional.

The role of Cyclophosphamide in my treatment :

Cyclophosphamide has become an integral part of my cancer treatment, and I have experienced its positive impact firsthand. In conjunction with other therapies, it has helped to suppress cancer cells and slow down tumor growth. However, like any treatment, it also comes with its fair share of side effects. Discussing these potential adverse reactions with my doctor and having a strong support system in place has been crucial in managing the challenges associated with Cytoxan usage.

Personal experiences and benefits :

I wanted to share some of the personal experiences I’ve had with Cyclophosphamide. It has provided me with a renewed sense of hope and has allowed me to actively fight against cancer. Besides its therapeutic benefits, the emotional support I have received from my loved ones, online cancer support groups, and fellow patients who have also experienced the positive effects of Cytoxan has been invaluable.

Conclusion :

In conclusion, my journey with Cyclophosphamide has been both challenging and rewarding. It is essential to approach the use of this medication with caution and under the guidance of healthcare professionals. Online pharmacies can be a convenient option, but thorough research and verification are necessary to ensure the authenticity and safety of the medication. With the right support system in place, including healthcare professionals, friends, and loved ones, Cyclophosphamide can offer hope and efficacy in the battle against cancer. Stay strong, and remember, we are not alone in this fight.

From 2021.

Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) present with a range of symptoms including post-exertional malaise (PEM), orthostatic intolerance, and autonomic dysfunction. Dysfunction of the blood vessel endothelium could be an underlying biological mechanism, resulting in inability to fine-tune regulation of blood flow according to the metabolic demands of tissues. The objectives of the present study were to investigate endothelial function in ME/CFS patients compared to healthy individuals, and assess possible changes in endothelial function after intervention with IV cyclophosphamide.

Symptoms frequently present following an event such as infection, physical trauma or exposure to environmental factors (4), and there is evidence of a genetic predisposition (8, 9). Research suggests the involvement of the immune system (10, 11), an impaired energy metabolism (12–14) and alterations in the gut microbiome (15). Orthostatic intolerance and autonomic dysfunction are also frequently reported, and can present with symptoms such as light-headedness, nausea, concentration difficulties, sweating, palpitations, dyspnea, and chest pain after prolonged sitting or standing.

It has been suggested that a dysfunction of the blood vessel endothelium could be a contributing mechanism, possibly associated with inadequate fine-tuned regulation of blood flow according to the metabolic demands of tissues (16, 17). One possible explanation for such endothelial dysfunction could be a reduced bioavailability of nitric oxide (NO) derived from endothelial cells. NO is a messenger molecule and neurotransmitter with important effects on vasodilation, thus contributing to the regulation of blood flow to tissues. NO is involved in many biologic processes, including effects on cognitive function, smooth muscle tone in the gastrointestinal and urogenital tracts, cardiac contractility, skeletal muscle and mitochondrial function (18, 19). Non-invasive measures for endothelial function include flow-mediated dilation (FMD) of the large arteries, which is believed to reflect the release of NO from endothelial cells caused by shear stress in vessel walls (20–22). As part of an FMD investigation, it is recommended to also measure endothelium-independent vasodilation, reflecting smooth muscle function, through the administration of sublingual nitroglycerin (20, 21). In the microcirculation, the measure post-occlusive reactive hyperemia (PORH) is understood to represent a more complex response involving nervous and myogenic responses as well as several vasodilators including NO (23).

There is growing evidence for endothelial dysfunction in autoimmune diseases (20, 24, 25) and fibromyalgia (26). However, research into blood vessel function in ME/CFS is limited so far. A study by Newton and colleagues (16) showed reduced FMD and PORH in a group of ME/CFS patients compared to healthy controls. This finding was confirmed by Scherbakov et al. who reported peripheral endothelial dysfunction in 18 of 35 (51%) ME/CFS patients compared to 4 of 20 (20%) healthy controls. This study also indicated a correlation between endothelial dysfunction and disease severity (17). In contrast, another study of 24 ME/CFS patients and 24 sedentary controls, using a different assessment method, found no significant difference in peripheral endothelial function at rest or after exercise (27).

This study investigated endothelial function in ME/CFS, and was the first to describe the changes in endothelial function before and after therapeutic intervention with IV cyclophosphamide in ME/CFS patients. Endothelial function measurements at baseline indicated that at the group level, the patients had significantly reduced large and small vessel endothelial function compared to healthy individuals, in line with results from previous studies (16, 17). Although more than half of the patients met the criteria for clinical response during the study, we were unable to detect any significant associations between clinical response and changes in endothelial function from baseline to 12 months follow-up.

Flow-mediated dilation (FMD) is the “gold-standard” method for large vessel endothelial function assessment (21), and the measurements have followed a well-established protocol.

One might speculate that endothelial dysfunction in ME/CFS could be associated with inadequate autoregulation of blood flow according to the demands of tissues, with resulting local hypoxia and lactate accumulation upon limited exertion. The clinical symptoms of ME/CFS suggest inadequate regulation of autonomic functions including blood flow. In a recent study of invasive cardiopulmonary exercise testing in upright position in ME/CFS patients, two types of peripheral neurovascular dysregulation were demonstrated; reduced cardiac output due to impaired venous return with low ventricular filling pressure (“preload failure”), and arterio-venous shunting with impaired peripheral oxygen extraction (53). These physiological changes are plausible contributors to several hallmark symptoms of ME/CFS, such as post-exertional malaise, and are associated with microcirculatory dysregulation, possibly related to small-fiber neuropathy (53).

Measures of known metabolites associated with endothelial function in cardiovascular diseases (Arg, hArg, ADMA, and SDMA) showed no significant differences between ME/CFS patients and healthy controls. This may argue for a different mechanism underlying the observed endothelial dysfunction in ME/CFS. We speculate that among ME/CFS patients, many of whom are relatively young women, the endothelial dysfunction could be related to an initial abnormal immune response, rather than atherosclerosis.

Further research is required in order to reach firm conclusions on any possible associations between ME/CFS symptoms and endothelial function. Future studies should aim to integrate objective activity measures as a supplement to validated patient-reported outcome measures, in order to control for the effect of physical activity or inactivity.

The central nervous system (CNS) is more commonly affected than the peripheral nervous system in Systemic Lupus Erythematosus (SLE). Neuropsychiatric or CNS signs are widespread, ranging from 24-54 percent, while peripheral nervous system involvement is less common, at roughly 5-27 percent. Chronic Inflammatory Demyelinating Polyradiculopathy (CIDP) is one of the three most common peripheral nerve system involvements in SLE patients, and it can be very disabling.

The goal of this study is to examine all SLE patients who have developed CIDP and report on their clinical symptoms, treatment, and progress, as well as a brief review of the literature on CIDP in SLE patients.

Methods: A retrospective review of all SLE patients diagnosed with CIDP between 2000 and 2015 who were followed up at our centre was conducted. We investigated their clinical presentation, investigations, treatment, response to therapy, and any neurological sequelae in their medical records.

There were 512 case notes analysed in total. These four patients, all between the ages of 26 and 46, presented with CIDP (3 females and 1 man). Three of the patients had transverse myelitis, while the fourth had acute motor and sensory axonal neuropathy. All of the patients were given high-dose corticosteroids, three of them were given cyclophosphamide, and the other was given mycophenolate mofetil. One patient had a complete recovery, two had persistent but improving numbness, and the third had lingering weakness. Two of our patients acquired CIDP shortly after being diagnosed with SLE, while the other two developed it much later in the course of their disease.

Conclusion: Involvement of the peripheral nerve system in SLE can have major disabling consequences. Early detection and treatment are critical for reducing neurological consequences.

Author(S) Details

Rozita Mohd

Nephrology Unit, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Cheras Kuala, Lumpur, Malaysia.

Fatimah Zanirah Nordin

Nephrology Unit, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Cheras Kuala, Lumpur, Malaysia.

Rizna Cader

Nephrology Unit, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Cheras Kuala, Lumpur, Malaysia.

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