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Cyclophosphamide Cytoxan Damage

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Will I die of cyclophosphamide (cytoxan) induced cardiomyopathy someday? Or maybe die of hemohorragic cystitis that leads to bladder cancer? Impossible to predict. I can say, however, that the chemotherapy regimens prescribed to me by my oncologist Dr. Berger, were incredibly toxic and did cause  nasty late stage side effects called

If you have been diagnosed with cancer, how would you feel about being given a toxic therapy? Yes, it may kill lots of your cancer but it will also cause lots of short and long-term damage.

If you have to undergo toxic  chemotherapy, how would you feel about undergoing evidence-based but non-conventional therapies shown to reduce and  possibly prevent the nasty long-term side effects that I developed?

High-dose cytoxan, also known as high-dose cyclophosphamide, is a chemotherapy drug that is used in the treatment of various types of cancer and autoimmune disorders. Like any medical treatment, it has both potential benefits (pros) and risks (cons). Here are some of the pros and cons of high-dose cytoxan:


  1. Effective Against Cancer: High-dose cytoxan can be very effective in treating certain types of cancer, including lymphomas, leukemias, and some solid tumors.
  2. Suppression of the Immune System: In autoimmune disorders, high-dose cytoxan can suppress the immune system’s abnormal response, helping to alleviate symptoms and slow the progression of the disease.
  3. Allogeneic Stem Cell Transplant: High-dose cytoxan is often used as part of a conditioning regimen before an allogeneic stem cell transplant. This helps to suppress the patient’s immune system and reduce the risk of rejection.


  1. Bone Marrow Suppression: High-dose cytoxan can lead to bone marrow suppression, which can result in decreased production of blood cells (anemia, leukopenia, thrombocytopenia). This can lead to an increased risk of infections, bleeding, and fatigue.
  2. Nausea and Vomiting: Like many chemotherapy drugs, high-dose cytoxan can cause nausea and vomiting. This can usually be managed with anti-emetic medications.
  3. Hair Loss (Alopecia): High-dose cytoxan can cause hair loss, which can be emotionally distressing for some patients.
  4. Increased Risk of Infections: Due to the suppression of the immune system, patients receiving high-dose cytoxan are at an increased risk of infections. Precautions may be necessary, and patients may need to avoid contact with sick individuals.
  5. Risk of Secondary Cancers: There is a small risk of developing secondary cancers, particularly bladder cancer, after treatment with high-dose cytoxan.
  6. Toxic to Organs: High-dose cytoxan can be toxic to certain organs, including the kidneys and bladder. Regular monitoring of kidney function is important during treatment.
  7. Fertility Issues: High-dose cytoxan can lead to temporary or permanent infertility, especially in men.
  8. Potential for Allergic Reactions: Some individuals may experience allergic reactions to cytoxan, which can range from mild to severe.

I’m curious. Am I being a wimp when I complain about all of the toxicity of conventional oncology? Or do you think conventional oncology should learn more about evidence-based but non-conventional therapies?


David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Cyclophosphamide-induced cardiomyopathy: a report of two cases and review of the English literature.   1979 Jun;43(6):2223-6.

“Fatal cardiomyopathy developed in two patients receiving cyclophosphamide in preparation for bone marrow transplantation. Both patients had normal EKGs prior to receiving cyclophosphamide in total doses of 168 mg/kg (case 1) and 144 mg/kg (case 2) and subsequently developed loss of voltage and ST-T wave changes. One patient (case 1) died of CHF and hypotension while the other patient (case 2) developed tamponade.

Prior to this report, the lowest total dose of cyclophosphamide reported to cause fatal cardiomyopathy was 180 mg/kg. In contrast to anthracycline congestive cardiomyopathy, the effects of cyclophosphamide appear to have an acute onset and do not appear to be the cumulative result of drug dosing. Postmortem examination in both patients revealed thickened left ventricles with intramyocardial hemorrhage.”

Fatal cyclophosphamide cardiomyopathy: its clinical course and treatment.

Bone Marrow Transplantation

Acute decompensating cardiomyopathy induced by cyclophosphamide is usually irreversible. To investigate the clinical course and the outcome of therapy, 13 patients (1.7%) with grade III acute cardiomyopathy and hypotension who were treated with ablative transplant regimens between January 1980 and September 1995 were analyzed.
Eight of nine patients died of acute fatal restrictive cardiomyopathy with unresponsive hypotension (ARCH), whereas three of four patients who survived the initial episode died of subacute congestive heart failure (SCHF). Acute fatal restrictive cardiomyopathy was characterized with extreme sensitivity to volume overload, myocardial edema and a rapidly fatal course. It was associated with progressive, unresponsive hypotension, reduced left ventricular stroke work index (LVSWI: 29.29 +/- 9.74 g-m/beat/m2) and markedly reduced systemic and pulmonary vascular resistance indices (SVRI: 429.72 +/- 168.84, PVRI: 58.63 +/- 45.08 dyne.sec/cm5.m2).
Subacute CHF was identified by myocardial edema, dilated chambers and biventricular pump failure represented by decreases in fractional shortening (FS: 19.5 +/- 4.9%). Of 10 patients who received conventional therapy, nine died and one sustained chronic CHF. One of three patients with ARCH on antioxidant therapy of ascorbic acid and theophylline survived the episode.
The data suggests peripheral vascular collapse may also be responsible for fatal ARCH.”


“Acute haemorrhagic cystitis is a troublesome complication of high dose cyclophosphamide administration. Bladder toxicity has been reported in 4-36 per cent of patients receiving this drug []. Acute cystitis – the commonest form of bladder toxicity, is characterized by dysuria, frequency and haematuria, in absence of bacteriuria. Cystitis usually develops within 24 to 48 hours after drug exposure and lasts for 5-7 days []. Severe cases manifest with frank haematuria, passage of clots which can lead to obstructive uropathy [, ]..”

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Doxorubicin Congestive Heart Failure - PeopleBeatingCancer says a few months ago

[…] Adding to my increasing risk of chemotherapy-induced cardiomyopathy, my oncologist prescribed two rounds of high-dose cytoxan aka cyclophosphomide. […]

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