II. Indications

  1. FDA Approved (replaced by newer agents for these indications)
    1. Breast Adenocarcinoma
    2. Ovarian Adenocarcinoma
    3. Bladder Superficial Papillary Carcinoma
    4. Hematopoetic Stem Cell Transplant (combined with other agents for pediatric class 3 Beta Thalassemia)
  2. Off-Label
    1. Hematopoetic Stem Cell Transplant (for CNS neoplasms)
    2. Leptomeningeal Metastases (administered via intrathecal route)
    3. Lymphoma

III. Mechanism

  1. Aziridine alkylating Antineoplastic Agent
    1. Derived from triethylenephosphoramide (TEPA)
    2. Prodrug that metabolizes in vivo to active ethylenimine groups
  2. Ethylenimine groups bind DNA at guanine's N7 position
    1. Cross-links DNA, blocks cell growth and division

IV. Medications

  1. Lypholized powder for injection: 15 mg, 100 mg

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Adverse Effects

  1. Alopecia
  2. Bone Marrow Suppression
  3. Secondary Malignancy
  4. Impaired future fertility

VII. Safety

  1. Avoid in Lactation
  2. Avoid in Pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count

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