Description of the medicine: Hexaphosphamide (Hexaphosphamidum)
Thiophosphoric N, N'-di- (Ethyleneimide) -N "-cyclohexylamide.
White crystalline powder. Sensitive to light. It is practically insoluble in water, it is hardly soluble in alcohol.
It has anti-leukemia activity. In large doses, inhibits hematopoiesis (especially granulocytopoiesis).
Applied with exacerbations of chronic myelogenous leukemia. The drug should be treated with leukemic and subleukemic forms of the disease, especially cases with severe hepato- and splenomegaly. Hexaphosphamide is prescribed both as the first therapeutic agent, and after treatment with other cytostatic 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 is not higher than 100 x 10 9 / l, they start with 10 mg per day, in the absence of a pronounced effect, the daily dose is increased to 20 mg.
Usually the therapeutic effect of the drug occurs after 1 to 3 weeks. In the absence of a therapeutic effect after 3 to 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 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 continues for 2 weeks after its withdrawal.
With a rapid decrease in the number of leukocytes, the intervals between individual doses of the drug should be increased to 3 to 7 days, with a mandatory preliminary analysis of peripheral blood before each dose.
Hexaphosphamide treatment of patients receiving other cytostatic agents should be started no earlier than 1 month after their cancellation. Upon reaching remission or persistent improvement, the main course of therapy is considered completed and the patient is under observation. If there is a tendency to increase the number of leukocytes in the blood more than 9 x 10 9 - 10 x 10 9 / l, it is advisable to carry out maintenance treatment with hexaphosphamide at a dose of 20 mg once every 3 to 7 days, depending on the data from the analysis of peripheral blood.
Hexaphosphamide has a pronounced inhibitory effect on leukopoiesis and to a lesser extent on thrombocytopoiesis. With an overdose of the drug or in case of increased individual sensitivity, the development of leukopenia, thrombocytopenia and severe inhibition of hematopoiesis are possible. After discontinuation of the drug, these phenomena usually stop after 2 to 4 weeks on their own. In case of more persistent cytopenia, the use of hemostimulating therapy is recommended: corticosteroid hormones, B vitamins, folic acid, fresh citrate blood transfusion of 250 ml 3 - 7 times a week. With severe inhibition of hematopoiesis, in addition to the above funds, the introduction of leukocyte mass or allogeneic bone marrow is indicated.