(100) Evaluation of Hyper-CVAD and Mini-CVD Regimens Without Mesna

Poster Abstract:

Background: Cyclophosphamide, a potent alkylating agent, is a component of many regimens in patients with acute lymphoblastic leukemia (ALL). Cyclophosphamide is a prodrug that is activated in the liver. Once activated it produces nitrogen mustard, acrolein, and up to 150 metabolites. The metabolite acrolein has been shown to cause pulmonary injury, cardiac injury, and the most common urological injury, in the form of hemorrhagic cystitis (HC). Mesna is a sulfhydryl compound that concentrates in the bladder; once mesna binds with acrolein it is readily excreted in the kidneys without causing HC. Mesna in hyper-CVAD and mini-CVD is administered as a continuous intravenous (IV) infusion concomitantly with cyclophosphamide. Both hyper-CVAD and mini-CVD regimens have been transitioned from inpatient to outpatient administration at some institutions. The feasibility of administering mesna as a continuous IV infusion is a difficult task to manage in the outpatient setting and adjustments to these regimens are warranted. Due to the recent adjustment from inpatient to outpatient administration of these regimens, data to support omission of mesna in hyper-CVAD and mini-CVD regimens is sparse.

Objective: The objective of this retrospective, single-center, chart review study is to evaluate the safety of hyper-CVAD and mini-CVD without mesna in a large academic medical center.

Methods: This retrospective, single-center, chart review study included adult patients (age ≥ 18 years) receiving hyper-CVAD or mini-CVD, with or without mesna, with an ALL diagnosis, from January 2021 to August 2023. Patients’ electronic medical records were reviewed and data was collected pertaining to: patient characteristics (patient age, gender, BMI, chemotherapy regimen, cycle number), cyclophosphamide characteristics (dose, cumulative dose, mesna use, IV hydration status), and laboratory values (urinalysis, serum creatinine, creatinine clearance). Other medications that the patient was taking at the time of cyclophosphamide administration were recorded. The primary endpoint of this study was the incidence of HC, diagnosed from hematuria and graded based on the Common Terminology Criteria for Adverse Events (CTCAE v5.0).

Results: Results are in progress.

Conclusions: Conclusions are in progress.

References (must also be included in final poster): Almalag HM, Alasmari SS, Alrayes MH, et al. Incidence of hemorrhagic cystitis after cyclophosphamide therapy with or without mesna: A cohort study and comprehensive literature review. J Oncol Pharm Pract. 2021;27(2):340-349.
Monach PA, Arnold LM and Merkel PA. Incidence and prevention of bladder toxicity from cyclophosphamide in the treatment of rheumatic diseases: a data-driven review. Arthritis Rheum 2010; 62: 9–21.
Bhat N, Kalthur SG, Padmashali S, et al. Toxic effects of different doses of cyclophosphamide on liver and kidney tissue in Swiss albino mice: a histopathological study. Ethiop J Health Sci 2018; 28: 711–716.