title: Cyclophosphamide metabolism in children with non-Hodgkin's lymphoma.
abstract: OBJECTIVE
  The purpose of our study was to determine whether variation in cyclophosphamide metabolism influences the incidence of recurrence among children receiving chemotherapy for B-cell non-Hodgkin's lymphoma.
  
  
  METHODS
  The pharmacokinetics and metabolism of cyclophosphamide were studied during a single course of treatment in 36 children receiving a uniform chemotherapy regimen for B-cell non-Hodgkin's lymphoma and were analyzed in terms of disease recurrence and hematological toxicity.
  
  
  RESULTS
  At a median follow-up of 43 months (range, 17-98 months), six children had developed recurrent disease, giving an overall disease-free survival of 83%. The median clearance of cyclophosphamide in patients who remain free of B-cell non-Hodgkin's lymphoma was 3.7 liter/h/m(2) (range, 2.3-5.0 liter/h/m(2)), compared with 2.2 (range, 1.5-2.5 liter/h/m(2)) in those with disease recurrence. Likelihood of recurrence was higher in patients with low clearance (<3.5 liter/h/m(2)) of cyclophosphamide (P < 0.01) and positively related to detection of the inactive metabolites carboxyphosphamide and dechloroethylcyclophosphamide in plasma (P = 0.01). There was no correlation between cyclophosphamide metabolism and hematological toxicity.
  
  
  CONCLUSIONS
  Inadequate clearance of cyclophosphamide to active metabolites is associated with increased risk of recurrence of B-cell non-Hodgkin's lymphoma in children. Modified chemotherapy strategies should be considered in patients who exhibit low rates of clearance of the parent drug and/or extensive production of inactive metabolites.
authors.affiliation: Department of Child Health, Yorkhill National Health Service Trust, Glasgow, United Kongdom.
authors.forename: S Murray
authors.initials: SM
authors.lastname: Yule
authors.forename: Lisa
authors.initials: L
authors.lastname: Price
authors.forename: Alex D
authors.initials: AD
authors.lastname: McMahon
authors.forename: Andrew D J
authors.initials: AD
authors.lastname: Pearson
authors.forename: Alan V
authors.initials: AV
authors.lastname: Boddy
mesh_terms: D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000493:pharmacokinetics; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000493:pharmacokinetics*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D008297:Male; D010752:Phosphoramide Mustards / Q000494:pharmacology; D012008:Recurrence; D013997:Time Factors
chemical_list: D018906:Antineoplastic Agents, Alkylating; D010752:Phosphoramide Mustards; D003520:Cyclophosphamide; C000028:carboxyphosphamide