Medication Description: Hexaphosphamide (Hexaphosphamidum)
N, N'-di- (Etilenimid) -N "-cyclohexylamide thiophosphoric acid.
White crystalline powder. Sensitive to the light. Practically insoluble in water, difficult to dissolve in alcohol.
It has anti-leukemia activity. In large doses, inhibits hemopoiesis (especially granulocytopoiesis).
Apply with exacerbations of chronic myeloid leukemia. Leukemic and subleukemic forms of the disease are subject to treatment with the drug, especially cases with severe hepato-and splenomegaly. Hexaphosphamide is prescribed both as a first therapeutic agent and after treatment with other cytotoxic drugs (myelosan, myelobromol, dopan, etc.) with their insufficient effectiveness.
Apply the drug inside. Usually the daily dose for adults is 20 mg (0.02 g). When the number of leukocytes in the blood does not exceed 100 x 10 9 / l, they start from 10 mg per day, in the absence of a pronounced effect, the daily dose is increased to 20 mg.
Typically, the therapeutic effect of the drug occurs in 1 - 3 weeks. In the absence of a therapeutic effect in 3 - 4 weeks, the dose can be gradually increased, in some cases up to 40 - 80 mg. The course of treatment with hexaphosphamide and course doses depend on the clinical effect and the hematological picture.
With a decrease in the number of leukocytes in the blood to 20 x 10 9 - 30 x 10 9 / l, the intake of hexaphosphamide should be discontinued, since the effect of the drug lasts for 2 weeks and after its cancellation.
With a rapid decrease in the number of leukocytes, the intervals between the individual doses of the drug should be increased to 3 to 7 days, with a mandatory preliminary analysis of peripheral blood before each administration of the drug.
Treatment with hexaphosphamide patients who received other cytotoxic drugs, should begin no earlier than 1 month after their cancellation. When remission or sustained improvement is achieved, the main course of therapy is considered to be completed and follow-up is carried out on the patient. If there is a tendency to an increase in the number of leukocytes in the blood of more than 9 x 10 9 - 10 x 10 9 / l, it is advisable to carry out maintenance treatment with hexaphosphamide in a dose of 20 mg 1 time in 3 to 7 days, depending on the data of peripheral blood analysis.
Hexaphosphamide has a pronounced inhibitory effect on leukopoiesis and to a lesser extent on thrombocytopoiesis. In case of an overdose of the drug or in case of increased individual sensitivity, the development of leukopenia, thrombocytopenia and a strong inhibition of blood formation are possible. After discontinuation of the drug, these effects usually stop in 2–4 weeks on their own. In the case of more stable cytopenia, the use of hemostimulating therapy is recommended: corticosteroid hormones, B vitamins, folic acid, transfusion of fresh citrate in 250 ml 3–7 times a week. With a strong inhibition of hematopoiesis, in addition to the above means, the introduction of leukocyte mass or allogeneic bone marrow is indicated.