Acrolein
from cyclophosphamide
“Ketchup bloodies the bladder”
direct injury to bladder urothelium
the other metabolite of cyclophosphamide is phosphoramide mustard
What it isA reactive aldehyde metabolite of cyclophosphamide and ifosfamide.
Why it mattersConcentrating in urine, it attacks the bladder wall — the cause of hemorrhagic cystitis and the bladder-cancer signal of the oxazaphosphorines.
What it changesMesna exists solely to neutralize it in the urine, which is why mesna co-administration and hydration are standard with these agents.
NO BOXED WARNINGS