Cyclophosphamide

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

Cyclophosphamide is a chemotherapy and immunosuppressant drug; it is also sold under the names Endoxan, Cyclonex and Cycloblastin.[1] 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.)[2]

Theory[edit | edit source]

Evidence[edit | edit source]

Norwegian Study - Cyclo/ME[edit | edit source]

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.[3] 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).[3] The authors urged caution due to the lack of a control group. The presence of 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.[4][5]

See also
CycloME.

Risks & safety[edit | edit source]

Rekeland et al. 2020 reported a number of adverse effects, including one unexpected suspected serious adverse reaction - a worsening of POTS. Commonly reported side effects were nausea and constipation, and side effects affected 8 out of 40 patients.[3]

Costs & availability[edit | edit source]

At present, only one clinical trial site, CycloME, is testing cyclophosphamide for use in ME/CFS.[5]

Notable studies[edit | edit source]

  • 2020, Intravenous Cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An Open-Label Phase II Study[3] - (Full text)
  • 2021, Reduced Endothelial Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome–Results From Open-Label Cyclophosphamide Intervention Study[6] - (Full text)

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. ↑ Healthdirect Australia. "Cyclophosphamide". Healthdirect Australia. Retrieved December 30, 2021.
  2. ↑ Chemocare. "Cyclophosphamide - Drug Information". chemocare.com. Retrieved May 6, 2020.
  3. ↑ 3.0 3.1 3.2 3.3 Rekeland, Ingrid G.; Fosså, Alexander; Lande, Asgeir; Ktoridou-Valen, Irini; Sørland, Kari; Holsen, Mari; Tronstad, Karl J.; Risa, Kristin; Alme, Kine; Viken, Marte K.; Lie, Benedicte K.; Dahl, Olav; Mella, Olav; Fluge, Øystein (2020). "Intravenous Cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An Open-Label Phase II Study". Frontiers in Medicine. 7: 162. doi:10.3389/fmed.2020.00162. ISSN 2296-858X. PMC 7201056. PMID 32411717.
  4. ↑ "Cyclophosphamide in Myalgic Encephalopathy/ Chronic Fatigue Syndrome (ME/CFS)". clinicaltrials.gov. Retrieved May 6, 2020.
  5. ↑ 5.0 5.1 "Forsking på ME". Helse Bergen (in norsk). April 30, 2020. Retrieved May 6, 2020.
  6. ↑ Sørland, Kari; Sandvik, Miriam Kristine; Rekeland, Ingrid Gurvin; Ribu, Lis; Småstuen, Milada Cvancarova; Mella, Olav; Fluge, Øystein (2021). "Reduced Endothelial Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome–Results From Open-Label Cyclophosphamide Intervention Study". Frontiers in Medicine. 8: 294. doi:10.3389/fmed.2021.642710. ISSN 2296-858X. PMC 8019750. PMID 33829023.

T cell A type of white blood cell which is mostly produced or matured in the thymus gland (hence T-cell) and is involved in the adaptive immune response on a cellular level. Also known as a T lymphocyte. (Learn more: www.youtube.com)

Any unintended or unwanted response to a treatment, whether in a clinical trial or licensed treatment. May be minor or serious.[1]

adverse reaction Any unintended or unwanted response to a treatment, whether in a clinical trial or licensed treatment. May be minor or serious.

adverse reaction Any unintended or unwanted response to a treatment, whether in a clinical trial or licensed treatment. May be minor or serious.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

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