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g. Skin rash: Ten to 20% of patients develop a diffuse maculo- 
papular rash 24-72 hours following CTX. The rash usually 
clears in 24-48 hours. 
h. Anemia: Hemoglobin drops can occur at this dose, presumably 
due to hemolysis. 
i. Reproduction: The long term effects are unknown but sterility 
is probable. 
9.3 Mesna (MESNCX) NDC #0015-3561-41 
Mesna is a sulfhydryl compound, 2-mercaptoethane sulfonate which has been 
shown in clinical studies to be effective in preventing CTX induced 
hemorrhagic cystitis. Mesna combines with and inactivates the metabolites of 
CTX which are toxic to the mucosa of the bladder. On entering the plasma, 
Mesna is oxidized to a polar disulfide (dimesna) which does not react with 
cytoxan metabolites. The kidney then transforms dimesna back to mesna 
which inactivates cytoxan metabolites in the urine. Thus, Mesna does not 
interfere with the antineoplastic and immunosuppressive effects of cytoxan but 
does selectively protect the bladder epithelium from its toxic metabolites. 
9.3.1 Dosage: 
a. Supplied as 400 mg/4 ml vial. 
b. Dissolved in D 5 W to 20 mg/ml concentration. 
c. Mesna 12 mg/kg is delivered IV over 15 minutes prior to CTX 
and 3, 6, 9, and 12 hours after each dose of cytoxan. 
d. Total 20 doses Mesna (5 for each dose of CTX) will be ad- 
ministered with BU/CTX preparatory regimen. 
9.3.2 Toxicities: 
In general, adverse reactions to mesna have been mild and readily 
managed including headaches, arthralgia and diarrhea. Hypotension 
and allergy were reported in 1/6 patients on phase I study. 
9.4 4-Hydroxyperoxy-cyclophosphamide 
Pergamid™ ( 4 -Hydroperoxycyclophosphamide) is supplied by Nova 
Pharmaceutical Corporation as a sterile powder in vials containing 200 mg 4- 
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