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Cyclophosphamide
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'''Cyclophosphamide''' is a chemotherapy and immunosuppressant drug; it is also sold under the names '''Endoxan''', '''Cyclonex''' and '''Cycloblastin'''.<ref>{{Cite web | url = https://www.healthdirect.gov.au/medicines/medicinal-product/aht,20684/cyclophosphamide | title = Cyclophosphamide | last = Healthdirect Australia | first = | authorlink = | date = | website = Healthdirect Australia|language=en| archive-url = | archive-date = |url-status = | access-date=2021-12-30}}</ref> Cyclophosphamide is often used as an adjuvant drug with other chemotherapy medications especially for leukemia and lymphomas. (These cancers include Hodgkin’s and non-Hodgkin's lymphoma, Burkitt's lymphoma, chronic lymphocytic leukemia (CLL), chronic myelocytic leukemia (CML), acute myelocytic leukemia (AML), acute lymphocytic leukemia (ALL), T-cell lymphoma (mycosis fungoides), multiple myeloma, neuroblastoma, retinoblastoma, rhabdomyosarcoma, Ewing's sarcoma; breast, testicular, endometrial, ovarian, and lung cancers, and in conditioning regimens for bone marrow transplantation.)<ref>{{Cite web | url = http://chemocare.com/chemotherapy/drug-info/cyclophosphamide.aspx | title = Cyclophosphamide - Drug Information | last = Chemocare | first = | authorlink = | date = | website = chemocare.com|archive-url=|archive-date=|access-date=2020-05-06}}</ref> ==Theory== ==Evidence== ===Norwegian Study - Cyclo/ME=== There is only limited evidence for the use of the drug cyclophosphamide to treat [[ME/CFS]], and only for patients who meet the [[Canadian Consensus Criteria]].<ref name="Rekeland2020" /> In the study, Rekeland et al. (2020) found that intravenous cyclophosphamide improved symptoms in over 50% of patients, and this improvement was maintained in the long term. In the trial 55% of patients responded positively to the drug, with an improvement in fatigue and overall physical functioning, with 68% of the responders having sustained remission of ME/CFS after 4 years (15 of the 40 patients).<ref name="Rekeland2020" /> The authors urged caution due to the lack of a control group. The presence of [[Human leukocyte antigen genes|HLA genes]] [[HLA-DQB1]]*03:03 and/or [[HLA-C]]*07:04 was associated with patients who responded positively to the cyclophosphamide. A Norwegian group, led by the researchers, Dr. [[Øystein Fluge]] and Professor [[Olav Mella]], who have been studying [[Rituximab]] use in [[ME/CFS]], also ran a clinical trial, called [[CycloME]]. The trial tested the effects of cyclophosphamide on [[ME/CFS]] patients that have been non-responders to [[Rituximab]].<ref>{{Cite web | url = https://clinicaltrials.gov/ct2/show/NCT02444091 | title = Cyclophosphamide in Myalgic Encephalopathy/ Chronic Fatigue Syndrome (ME/CFS) | last = | first = | authorlink = | date = | website = clinicaltrials.gov|language=en|archive-url=|archive-date=|access-date=2020-05-06}}</ref><ref name=":0">{{Cite web | url = https://helse-bergen.no/avdelinger/kreftbehandling-og-medisinsk-fysikk/forsking-pa-me | title = Forsking på ME | last = | first = | authorlink = | date = 2020-04-30 | website = Helse Bergen|language=no-nn|archive-url=|archive-date=|access-date=2020-05-06}}</ref> {{See also|CycloME}} ==Risks & safety== Rekeland et al. 2020 reported a number of adverse effects, including one unexpected suspected serious adverse reaction - a worsening of [[postural orthostatic tachycardia syndrome|POTS]]. Commonly reported side effects were [[nausea]] and [[constipation]], and side effects affected 8 out of 40 patients.<ref name="Rekeland2020" /> ==Costs & availability== At present, only one clinical trial site, [[CycloME]], is testing cyclophosphamide for use in [[ME/CFS]].<ref name=":0" /> == Notable studies == * 2020, Intravenous Cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An Open-Label Phase II Study<ref name="Rekeland2020">{{Cite journal | last = Rekeland | first = Ingrid G. | authorlink = | last2 = Fosså | first2 = Alexander | authorlink2 = | last3 = Lande | first3 = Asgeir | author-link3 = | last4 = Ktoridou-Valen | first4 = Irini | author-link4 = | last5 = Sørland | first5 = Kari | author-link5 = | last6 = Holsen | first6 = Mari | author-link6 = | last7 = Tronstad | first7 = Karl J. | author-link8 = Karl Tronstad | last8 = Risa | first8 = Kristin | author-link8 = | last9 = Alme | first9 = Kine | author-link9 = | date = 2020 | title=Intravenous Cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An Open-Label Phase II Study | url = https://www.frontiersin.org/articles/10.3389/fmed.2020.00162/full|journal=Frontiers in Medicine|language=English|volume=7|issue= | pages = 162|pmc=PMC7201056|pmid=32411717|doi=10.3389/fmed.2020.00162|issn=2296-858X|quote=|via= | last10 = Viken | first10 = Marte K. | author-link10 = | last11 = Lie | first11 = Benedicte K. | author-link11 = | last12 = Dahl | first12 = Olav | author-link12 = | last13 = Mella | first13 = Olav | author-link13 = Olav Mella | first14 = Øystein | last14 = Fluge | author-link14 = Øystein Fluge}}</ref> - [https://www.frontiersin.org/articles/10.3389/fmed.2020.00162/full? (Full text)] *2021, Reduced Endothelial Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome–Results From Open-Label Cyclophosphamide Intervention Study<ref name="Sorland2021">{{Cite journal | title = Reduced Endothelial Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome–Results From Open-Label Cyclophosphamide Intervention Study | date = 2021 | url=https://www.frontiersin.org/article/10.3389/fmed.2021.642710|journal=Frontiers in Medicine|volume=8|issue= | pages = 294 | last = Sørland | first = Kari | authorlink = | last2 = Sandvik | first2 = Miriam Kristine | authorlink2 = | last3 = Rekeland | first3 = Ingrid Gurvin | author-link3 = | last4 = Ribu | first4 = Lis | author-link4 = | last5 = Småstuen | first5 = Milada Cvancarova | author-link5 = | last6 = Mella | first6 = Olav | author-link6 = Olav Mella | last7 = Fluge | first7 = Øystein | author-link8 = Øystein Fluge|doi=10.3389/fmed.2021.642710|pmc=PMC8019750|pmid=33829023|issn=2296-858X|quote=|via=}}</ref> - [https://www.frontiersin.org/articles/10.3389/fmed.2021.642710/full (Full text)] ==Learn more== *[https://go.drugbank.com/drugs/DB00531 Cyclophosphamide] - DrugBank Online *[http://www.helse-bergen.no/en/OmOss/Avdelinger/kreft/forsking-fagutvikling/Sider/CycloME.aspx CycloME - Cyclophosphamide in ME/CFS] ==See also== *[[Rituximab]] *[[Autoimmune hypothesis]] *[[RituxME]] *[[CycloME]] *[[Human leukocyte antigen genes]] *[[Øystein Fluge]] *[[Olav Mella]] ==References== {{Reflist}} [[Category:Potential treatments]] [[Category:Immunomodulators]] [[category:Immunosuppressants]]
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