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Cyclophosphamide
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
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.[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]
Risks & safety
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
At present, only one clinical trial site, CycloME, is testing cyclophosphamide for use in ME/CFS.[5]
Notable studies
- 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
- Cyclophosphamide - DrugBank Online
- CycloME - Cyclophosphamide in ME/CFS
See also
- Rituximab
- Autoimmune hypothesis
- RituxME
- CycloME
- Human leukocyte antigen genes
- Øystein Fluge
- Olav Mella
References
- ↑ Healthdirect Australia. "Cyclophosphamide". Healthdirect Australia. Retrieved December 30, 2021.
- ↑ Chemocare. "Cyclophosphamide - Drug Information". chemocare.com. Retrieved May 6, 2020.
- ↑ 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.
- ↑ "Cyclophosphamide in Myalgic Encephalopathy/ Chronic Fatigue Syndrome (ME/CFS)". clinicaltrials.gov. Retrieved May 6, 2020.
- ↑ 5.0 5.1 "Forsking på ME". Helse Bergen (in norsk). April 30, 2020. Retrieved May 6, 2020.
- ↑ 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.
