Cyclophosphamide in transplant
Cyclophosphamide is a cyclic phosphamide ester of mechlorethamine. It is transformed via hepatic and intracellular enzymes to active alkylating metabolites, acrolein and phosphoramide mustard.
Cyclophosphamide causes prevention of cell division primarily by cross-linking DNA strands. It is considered to be cell cycle phase-nonspecific. Immune modulation with cyclophosphamide (and plasmapheresis, and intravenous gamma globulin) are methods used to desensitize transplant candidates with preformed anti-HLA antibodies to achieve successful transplantation.
“Immune system modulation in the highly sensitized transplant candidate”; Davidson BT, Donaldson TA: Crit Care Nurs Q. 2004 Jan-Mar;27(1):1-9.
Which of the following are alkylating agents?