Antibody & Biopsy
IV CYCLOPHOSPHAMIDE PROTOCOL
: This protocol is for use in patients with Motor, anti-MAG & IgM M-protein-related neuropathies.
: During each cycle of treatment patients receive
Hydration (1 to 1.5 liters)
of cyclophosphamide given intravenously over 3 to 4 hours
Further hydration (1 to 1.5 liters).
course of therapy
this regimen is given
6 times, one every 4 weeks.
Each treatment: Cyclophosphamide (Cytoxan), a total of 1.0 gm/M
intravenously over a period of 3 hours
Patients should be otherwise healthy and without evidence of infection for the prior 1-2 weeks
The protocol should probably be modified in debilitated patients
taken to avoid side effects include:
: Administration of 3-4 liters of fluid on the days of Cytoxan treatment.
1-1.5 liters of fluid before Cytoxan treatment
Fluid administered with Cytoxan treatment
The remainder of the fluid to be administered after Cytoxan treatment.
The IV fluid should be D5 0.5 NS administered at up to 150 cc/M
Fluid load should be modified for patients with abnormal cardiac function or who are otherwise debilitated.
Some of the post-treatment IV fluid may be replaced by p.o. intake.
- Zofran (Ondansetron) 0.15 mg/kg over 15 minutes: Give
Prophylactically beginning 30 minutes prior to each cyclophosphamide dose
4 and 8 hours after treatment
The patient should be sent home with enough antiemetics for 2-3 days.
should be kept during the patient's hospital stay.
: During and 1 day after treatment
All urine should be evaluated for heme.
Microscopic analysis of the urine should be performed after each medication dose.
The specific gravity on all urines should be determined.
After administration of Cytoxan,
should be changed before resuming regular IV hydration.
: Obtained before the first treatment and at intervals thereafter.
Heme-8, differential, platelets (every month)
Comprehensive metabolic panel (every month)
IgM: Quantitative levels
IgM vs GM1 or MAG (every 3 to 4 months): Send to
Neuromuscular Clinical Laboratory
Box 8111 - Neurology
660 South Euclid Avenue
St. Louis, MO 63110
- Return outpatient appointment is 1 to 2 months after the last treatment.
Double gloving on handling urine because Cytoxan is excreted in the urine.
Double gloving when spiking Cytoxan mini bottles.
Post dose disposal of empty container.
Quantitative dynamometry (Muscle strength, distal & proximal): Every 3 months
Quantitative sensory testing: RS tuning fork at toes, ankles, knees & fingers
Gait testing: Tandem gait up to 8 steps
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