cyclophosphamide

Adult Dosing .

Dosage forms:  CAP: 25 mg, 50 mg, INJ: various

Special Note

[uses, dosing may vary]

Info: refer to institution protocols and pkg insert prior to prescribing for uses, premeds, and dosing incl. toxicity-related dose adjustments

lymphoma

[PO route]

Dose: 1-5 mg/kg/dose PO qam; Info: for Hodgkin lymphoma, lymphocytic lymphoma, mixed-cell type lymphoma, histiocytic lymphoma, Burkitt lymphoma, or mycosis fungoides; do not open cap; maintain adequate hydration

[IV route]

Dose: 40-50 mg/kg IV in divided doses over 2-5 days of each cycle; Alt: 10-15 mg/kg/dose IV x1 on day 1 of 7- to 10-day cycle; 3-5 mg/kg/dose IV 2x/wk; Info: for Hodgkin lymphoma, lymphocytic lymphoma, mixed-cell type lymphoma, histiocytic lymphoma, Burkitt lymphoma, or mycosis fungoides; maintain adequate hydration

multiple myeloma

[PO route]

Dose: 1-5 mg/kg/dose PO qam; Info: do not open cap; maintain adequate hydration

[IV route]

Dose: 40-50 mg/kg IV in divided doses over 2-5 days of each cycle; Alt: 10-15 mg/kg/dose IV x1 on day 1 of 7- to 10-day cycle; 3-5 mg/kg/dose IV 2x/wk; Info: maintain adequate hydration

leukemia

[PO route]

Dose: 1-5 mg/kg/dose PO qam; Info: for CLL, chronic granulocytic leukemia, AML, or ALL; do not open cap; maintain adequate hydration

[IV route]

Dose: 40-50 mg/kg IV in divided doses over 2-5 days of each cycle; Alt: 10-15 mg/kg/dose IV x1 on day 1 of 7- to 10-day cycle; 3-5 mg/kg/dose IV 2x/wk; Info: for CLL, chronic granulocytic leukemia, AML, or ALL; maintain adequate hydration

solid tumors

[PO route]

Dose: 1-5 mg/kg/dose PO qam; Info: for neuroblastoma, retinoblastoma, breast CA, or ovarian CA; do not open cap; maintain adequate hydration

[IV route]

Dose: 40-50 mg/kg IV in divided doses over 2-5 days of each cycle; Alt: 10-15 mg/kg/dose IV x1 on day 1 of 7- to 10-day cycle; 3-5 mg/kg/dose IV 2x/wk; Info: for neuroblastoma, retinoblastoma, breast CA, or ovarian CA; maintain adequate hydration

axillary node positive breast CA, adjuvant tx (off-label)

[600 mg/m^2/dose IV x1 on day 1 of 21-day cycle]

Info: give x4 cycles; use w/ doxorubicin; maintain adequate hydration

CML, allogeneic HSCT conditioning tx (off-label)

[60 mg/kg/dose IV q24h on days -3, -2]

Info: use w/ busulfan; maintain adequate hydration

lymphodepleting tx, pre-afamitresgene autoleucel (off-label)

[melanoma-associated antigen A4 (MAGE-A4)-positive synovial sarcoma, unresectable or metastatic]

Dose: 600 mg/m^2/dose IV q24h x3 doses; Start: 7 days prior to tisagenlecleucel tx; Info: use w/ fludarabine; maintain adequate hydration

lymphodepleting tx, pre-axicabtagene ciloleucel (off-label)

[follicular lymphoma, relapsed or refractory]

Dose: 500 mg/m^2/dose IV q24h x3 doses; Start: 5 days prior to axicabtagene ciloleucel tx; Info: use w/ fludarabine; maintain adequate hydration

[large B-cell lymphoma, relapsed or refractory]

Dose: 500 mg/m^2/dose IV q24h x3 doses; Start: 5 days prior to axicabtagene ciloleucel tx; Info: use w/ fludarabine; maintain adequate hydration

lymphodepleting tx, pre-brexucabtagene autoleucel (off-label)

[mantle cell lymphoma, relapsed or refractory]

Dose: 500 mg/m^2/dose IV q24h x3 doses; Start: 5 days prior to brexucabtagene autoleucel tx; Info: use w/ fludarabine; maintain adequate hydration

[B-cell precursor ALL, relapsed or refractory]

Dose: 900 mg/m^2/dose IV x1; Start: 2 days prior to brexucabtagene autoleucel tx; Info: use w/ fludarabine; maintain adequate hydration

lymphodepleting tx, pre-ciltacabtagene autoleucel (off-label)

[multiple myeloma, relapsed or refractory]

Dose: 300 mg/m^2/dose IV q24h x3 doses; Start: 5 days prior to ciltacabtagene autoleucel tx; Info: use w/ fludarabine; maintain adequate hydration

lymphodepleting tx, pre-idecabtagene vicleucel (off-label)

[multiple myeloma, relapsed or refractory]

Dose: 300 mg/m^2/dose IV q24h x3 doses; Start: 5 days prior to idecabtagene vicleucel tx; Info: use w/ fludarabine; maintain adequate hydration

lymphodepleting tx, pre-lifileucel (off-label)

[melanoma, unresectable or metastatic]

Dose: 60 mg/kg/dose IV q24h x2 doses; Start: 8 days prior to lifileucel tx; Info: use w/ fludarabine; maintain adequate hydration

lymphodepleting tx, pre-lisocabtagene maraleucel (off-label)

[large B-cell lymphoma, relapsed or refractory]

Dose: 300 mg/m^2/dose IV q24h x3 doses; Start: 5 days prior to lisocabtagene maraleucel tx; Info: use w/ fludarabine; maintain adequate hydration

[CLL/SLL, relapsed or refractory]

Dose: 300 mg/m^2/dose IV q24h x3 doses; Start: 5 days prior to lisocabtagene maraleucel tx; Info: use w/ fludarabine; maintain adequate hydration

[follicular lymphoma, relapsed or refractory]

Dose: 300 mg/m^2/dose IV q24h x3 doses; Start: 5 days prior to lisocabtagene maraleucel tx; Info: use w/ fludarabine; maintain adequate hydration

[mantle cell lymphoma, relapsed or refractory]

Dose: 300 mg/m^2/dose IV q24h x3 doses; Start: 5 days prior to lisocabtagene maraleucel tx; Info: use w/ fludarabine; maintain adequate hydration

lymphodepleting tx, pre-obecabtagene autoleucel (off-label)

[B-cell precursor ALL, relapsed or refractory]

Dose: 500 mg/m^2/dose IV q24h x2 doses; Start: 6 days prior to obecabtagene autoleucel tx; Info: use w/ fludarabine; maintain adequate hydration

lymphodepleting tx, pre-tisagenlecleucel (off-label)

[B-cell precursor ALL, relapsed or refractory]

Dose: 500 mg/m^2/dose IV q24h x2 doses; Start: 6 days prior to tisagenlecleucel tx; Info: for pts 25 yo and younger; use w/ fludarabine; maintain adequate hydration

[large B-cell lymphoma, relapsed or refractory]

Dose: 250 mg/m^2/dose IV q24h x3 doses; Start: 5 days prior to tisagenlecleucel tx; Info: use w/ fludarabine; maintain adequate hydration

[follicular lymphoma, relapsed or refractory]

Dose: 250 mg/m^2/dose IV q24h x3 doses; Start: 5 days prior to tisagenlecleucel tx; Info: use w/ fludarabine; maintain adequate hydration

rheumatoid arthritis (off-label)

[1.5-3 mg/kg/dose PO qam]

Info: do not open cap; maintain adequate hydration

granulomatosis w/ polyangiitis (GPA) (off-label)

[PO route]

Dose: 2 mg/kg/dose PO qd x3-6mo; Max: 200 mg/day; Info: for induction tx; decr. dose by 25% in pts 60-70 yo or 50% in pts >70 yo; use w/ glucocorticoids; give PCP prophylaxis during tx and for at least 6mo after D/C; do not open cap; maintain adequate hydration

[IV route]

Dose: 15 mg/kg/dose IV q2wk x3 doses, then 15 mg/kg/dose IV q3wk for at least 3 doses; Max: 1200 mg/dose; Info: for induction tx; decr. dose to 12.5 mg/kg/dose in pts 60-70 yo or 10 mg/kg/dose in pts >70 yo; use w/ glucocorticoids; give PCP prophylaxis during tx and for at least 6mo after D/C; maintain adequate hydration

renal dosing

[granulomatosis w/ polyangiitis (GPA), PO route]

CrCl 50-99: 1.5 mg/kg/day; CrCl 25-49: 1.2 mg/kg/day; CrCl 15-24: 1 mg/kg/day; CrCl <15: 0.8 mg/kg/day

HD: 0.8 mg/kg/day, on dialysis days admin. after dialysis; no supplement; PD: 0.8 mg/kg/day; no supplement

[granulomatosis w/ polyangiitis (GPA), IV route]

CrCl <30: decr. usual dose by 2.5 mg/kg/dose

HD: decr. usual dose by 25%, on dialysis days admin. after dialysis; no supplement; PD: decr. usual dose by 25%; no supplement

[all other indications]

CrCl <10: decr. usual dose by 25%

HD: decr. usual dose by 25%, on dialysis days admin. after dialysis; no supplement; PD: decr. usual dose by 25%; no supplement

hepatic dosing

[see below]

hepatic impairment: not defined, caution advised

Peds Dosing .

Dosage forms:  CAP: 25 mg, 50 mg, INJ: various

Special Note

[uses, dosing may vary]

Info: refer to institution protocols and pkg insert prior to prescribing for uses, premeds, and dosing incl. toxicity-related dose adjustments

lymphoma

[PO route]

Dose: 1-5 mg/kg/dose PO qam; Info: for Hodgkin lymphoma, lymphocytic lymphoma, mixed-cell type lymphoma, histiocytic lymphoma, Burkitt lymphoma, or mycosis fungoides; do not open cap; maintain adequate hydration

[IV route]

Dose: 40-50 mg/kg IV in divided doses over 2-5 days of each cycle; Alt: 10-15 mg/kg/dose IV x1 on day 1 of 7- to 10-day cycle; 3-5 mg/kg/dose IV 2x/wk; Info: for Hodgkin lymphoma, lymphocytic lymphoma, mixed-cell type lymphoma, histiocytic lymphoma, Burkitt lymphoma, or mycosis fungoides; maintain adequate hydration

multiple myeloma

[PO route]

Dose: 1-5 mg/kg/dose PO qam; Info: do not open cap; maintain adequate hydration

[IV route]

Dose: 40-50 mg/kg IV in divided doses over 2-5 days of each cycle; Alt: 10-15 mg/kg/dose IV x1 on day 1 of 7- to 10-day cycle; 3-5 mg/kg/dose IV 2x/wk; Info: maintain adequate hydration

leukemia

[PO route]

Dose: 1-5 mg/kg/dose PO qam; Info: for CLL, chronic granulocytic leukemia, AML, or ALL; do not open cap; maintain adequate hydration

[IV route]

Dose: 40-50 mg/kg IV in divided doses over 2-5 days of each cycle; Alt: 10-15 mg/kg/dose IV x1 on day 1 of 7- to 10-day cycle; 3-5 mg/kg/dose IV 2x/wk; Info: for CLL, chronic granulocytic leukemia, AML, or ALL; maintain adequate hydration

solid tumors

[PO route]

Dose: 1-5 mg/kg/dose PO qam; Info: for neuroblastoma, retinoblastoma, breast CA, or ovarian CA; do not open cap; maintain adequate hydration

[IV route]

Dose: 40-50 mg/kg IV in divided doses over 2-5 days of each cycle; Alt: 10-15 mg/kg/dose IV x1 on day 1 of 7- to 10-day cycle; 3-5 mg/kg/dose IV 2x/wk; Info: for neuroblastoma, retinoblastoma, breast CA, or ovarian CA; maintain adequate hydration

nephrotic syndrome

[2 mg/kg/dose PO qam x60-90 days]

Info: do not open cap; maintain adequate hydration

allogeneic HSCT conditioning tx (off-label)

[50 mg/kg/dose IV q24h on days -5, -4, -3, -2]

Info: use w/ busulfan; maintain adequate hydration

lymphodepleting tx, pre-tisagenlecleucel (off-label)

[3 yo and older]

Dose: 500 mg/m^2/dose IV q24h x2 doses; Start: 6 days prior to tisagenlecleucel tx; Info: for pts w/ relapsed or refractory B-cell precursor ALL; use w/ fludarabine; maintain adequate hydration

renal dosing

[adjust dose amount]

CrCl <10: decr. usual dose by 25%

HD: decr. usual dose by 50%, on dialysis days admin. after dialysis; no supplement; PD: decr. usual dose by 25%; no supplement

hepatic dosing

[see below]

hepatic impairment: not defined, caution advised