title: Fractionated high-dose cyclophosphamide for advanced pediatric solid tumors.
abstract: OBJECTIVE
  The objective of this study was to determine the tolerance and toxicities of high-dose cyclophosphamide (CPA) at 7 g/m2 given in four fractions over 8 h in children with advanced solid tumors.
  
  
  METHODS
  Twenty children aged 1 1/2-19 years (median, 12 years) received 24 courses of high-dose CPA at 7 g/m2 for the treatment of advanced malignant solid tumor. CPA was given in four 1-h infusions of 1.75 g/m2 each, with 1 h of rest between each dose. MESNA was used as a uroprotective agent and was continued for 24 h after the final dose of CPA. With only one exception, all patients were discharged at the end of MESNA infusion and received granulocyte colony-stimulating factor, prophylactic ciprofloxacin, and co-trimoxazole.
  
  
  RESULTS
  Severe but transient myelosuppression was observed. The median time to neutrophil and platelet recovery was 17 and 19 days, respectively. Fever developed after 13 of the 24 courses, and hospitalization was required. Extramedullary toxicities were mild. No patient showed cardiomyopathy or hemorrhagic cystitis. Forty-six percent of the courses were managed entirely on an outpatient basis. Objective tumor response was seen in five patients.
  
  
  CONCLUSIONS
  CPA at 7 g/m2 is well tolerated by children with advanced malignancies and should be considered in earlier phases of antineoplastic therapy.
authors.affiliation: Department of Pediatrics, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: L L
authors.initials: LL
authors.lastname: Chan
authors.forename: J
authors.initials: J
authors.lastname: Ater
authors.forename: A
authors.initials: A
authors.lastname: Cangir
authors.forename: N
authors.initials: N
authors.lastname: Jaffe
authors.forename: R B
authors.initials: RB
authors.lastname: Raney
authors.forename: C
authors.initials: C
authors.lastname: Herzog
authors.forename: S
authors.initials: S
authors.lastname: Culbert
authors.forename: K W
authors.initials: KW
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D015080:Mesna / Q000627:therapeutic use; D009369:Neoplasms / Q000188:drug therapy*; D009447:Neuroblastoma / Q000188:drug therapy; D012516:Osteosarcoma / Q000188:drug therapy; D012509:Sarcoma / Q000188:drug therapy; D012512:Sarcoma, Ewing / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide; D015080:Mesna