Which side effect is associated with cyclophosphamide and can be mitigated by Mesna?

Cyclophosphamide is an alkylating agent that can lead to a number of side effects, one of which is hemorrhagic cystitis. This particularly concerning side effect arises due to the accumulation of toxic metabolites, specifically acrolein, in the urinary tract. When cyclophosphamide is metabolized in the liver, these metabolites can cause irritation and damage to the bladder lining, leading to inflammation and bleeding.

Mesna, or sodium 2-mercaptoethanesulfonate, is a protective agent that helps to neutralize the toxic effects of these metabolites. It works by binding to acrolein and other toxic metabolites in the urine, rendering them less harmful and facilitating their excretion. As a result, the use of Mesna significantly reduces the risk of hemorrhagic cystitis in patients receiving cyclophosphamide.

In contrast, other side effects of cyclophosphamide such as cardiotoxicity, nausea, and neutropenia are not addressed by Mesna. Cardiotoxicity is not directly related to the bladder toxicity managed by Mesna, while nausea is a common side effect from various chemotherapy agents and is managed through different anti-emetic therapies. Neutropenia, which is a decrease in white blood