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Cyclophosphamide Leucopenia Management — ESENeph MCQ

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EasyRenal VasculitisCyclophosphamide Leucopenia ManagementESENeph

A 50-year-old man with ANCA vasculitis develops leucopenia (WCC 1.5 x 10^9/L) while on Cyclophosphamide. What is the recommended management?

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Correct answer: B — Withhold Cyclophosphamide until WCC recovers; reduce dose on recommencement; monitor FBC regularly

Leucopenia is a dose-dependent adverse effect of Cyclophosphamide (myelosuppression). KDIGO 2024 AAV guideline recommends monitoring FBC every 2 weeks during IV Cyclophosphamide. If WCC falls below 2 x 10^9/L or neutrophils below 1 x 10^9/L, Cyclophosphamide should be withheld until recovery and subsequent doses reduced by 25%. This reduces infection risk while maintaining disease control. Nadir typically occurs 10-14 days after IV pulse.

Reference: KDIGO 2024 – AAV; BNF – Cyclophosphamide