S. Ren et al., PHARMACOKINETICS OF CYCLOPHOSPHAMIDE AND ITS METABOLITES IN BONE-MARROW TRANSPLANTATION PATIENTS, Clinical pharmacology and therapeutics, 64(3), 1998, pp. 289-301
Objectives: To characterize the pharmacokinetics of cyclophosphamide a
nd 5 of its metabolites in bone marrow transplant patients and to iden
tify the mechanism of the increase in 4-hydroxycyclophosphamide area u
nder the plasma concentration-time curve (AUC) from day 1 to day 2 of
cyclophosphamide administration.Methods: Cyclophosphamide was administ
ered by intravenous infusion (60 mg/kg over I hour, once a day) for 2
consecutive days to 18 patients. Cyclophosphamide and 4-hydroxycycloph
osphamide concentration-time data on day 1 and day 2 were fitted to a
model to estimate 4-hydroxycyclophosphamide formation (CLf) and elimin
ation (CLm) clearances. Erythrocyte aldehyde dehydrogenase-l activity
was measured ex vivo just before the first cyclophosphamide infusion w
as started (0 hours) and 24 hours after the second cyclophosphamide in
fusion (48 hours),Results: From day 1 to day 2, the AUC of cyclophosph
amide, deschloroethyl cyclophosphamide and phosphoramide mustard decre
ased 24.8%, 51%, and 29.4% (P < .02), the AUC of 4-hydroxycyclophospha
mide and carboxyethylphosphoramide mustard increased 54.7% and 25% (P
< .01), whereas the AUC of phosphoramide mustard was not significantly
changed (P > .3), The CLf of 4-hydroxycyclophosphamide increased 60%
(P < .001), its CLm decreased 27.7% (P < .001), and the fraction of cy
clophosphamide dose converted to 4-hydroxycyclophosphamide increased 1
6% (P < .001) from day 1 to day 2, The activity of patient erythrocyte
aldehyde dehydrogenase-l decreased 23.3% (P < .02) from 0 hours to 48
hours. Conclusions: The AUC of 4-hydroxycyclophosphamide increased fr
om day 1 to day 2 as a result of increased formation and decreased eli
mination clearances of 4-hydroxycyclophosphamide. Aldehyde dehydrogena
se-1 activity appears to decline as a consequence of cyclophosphamide
administration.