Efficacy, safety, and dose adjustment of cyclophosphamide in lymphoma patients requiring hemodialysis

Chemotherapy for non‐Hodgkin lymphoma in the hemodialysis patient: A comprehensive review

“…Conversely, Hamadah et al reported eight NHL patients on HD (cases 19‐22 and 33‐36) treated with CHOP‐like regimens with or without rituximab, and only two patients were able to complete their full six courses of therapy. In this study, five patients were able to complete only one course, and one patient was able to complete only three courses of CHOP‐like therapy with or without rituximab due to chemotherapy‐related toxicities 25 . This discrepancy between the two studies may be due to the fact that Ochi et al carried out significant dose reductions of DXR, pirarubicin, VCR, and CPA in patients aged 70 years and over, 30% dose reductions for patients aged 70‐79 years, and 50% dose reductions for patients aged 80 years and over 3 .…”

“…The anthracycline DXR and its major metabolite doxorubicinol are not predominantly eliminated by the kidneys, but the AUCs of DXR and doxorubicinol have been found to be higher in HD patients compared to non‐HD patients 62 . Some investigators have recommended a 10%‐20% dose reduction of DXR and VCR in HD patients, 27 while most others have recommended the standard dose 3,25 . Data concerning removal of DXR and VCR by HD are limited, and therefore these drugs should be administered after HD 3,4 .…”

“…Etoposide is not removed by HD and administration can be done before or after HD sessions 75 . Three NHL patients on HD have been treated with etoposide (cases 21, 22, and 57), two in conjunction with CHOP, and one as part of a modified proMACE/CytaBOM regimen (prednisolone + methotrexate + doxorubicin + cyclophosphamide + etoposide/cytarabine + bleomycin + vincristine + methotrexate) 25 . Etoposide dosage was not clarified in these patients.…”

“…Case reports and case series reporting on actual treatment of NHL patients on HD are shown in Table 1 (rituximab, CVP, and CHOP), 2,3,6,10‐35 Table 2 (various other regimens), 10,19,25,34‐51 and Table 3 (stem cell transplantation), 34,52‐54 and are discussed below. Recommendations on individual drug administrations are summarized in Table 4 3‐5,9‐11,19,25,38,39,43‐46,55‐60 .…”

“…Case reports and case series reporting on actual treatment of NHL patients on HD are shown in Table 1 (rituximab, CVP, and CHOP), 2,3,6,10‐35 Table 2 (various other regimens), 10,19,25,34‐51 and Table 3 (stem cell transplantation), 34,52‐54 and are discussed below. Recommendations on individual drug administrations are summarized in Table 4 3‐5,9‐11,19,25,38,39,43‐46,55‐60 . Despite the possible bias of case reports favoring cases with good outcomes, overall the rates of adverse events are high and outcomes of the extracted cases are dismal compared to their counterparts not on HD.…”