Mechlorethamine

 Risk Factor: DM
 Class: ANTINEOPLASTICS

Contents of this page:

Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

Mechlorethamine is an alkylating antineoplastic agent. The drug produced congenital malformations in rats and ferrets when given as a single SC injection of 1 mg/kg (23 times the maximum recommended human dose) (1).

Mechlorethamine has been used in pregnancy, usually in combination with other antineoplastic drugs. Most reports have not shown an adverse effect in the fetus even when mechlorethamine was given during the 1st trimester (2,3,4,5 and 6). Two malformed infants have resulted following 1st trimester use of mechlorethamine: Oligodactyly of both feet with webbing of third and fourth toes, four metatarsals on left, three on right, bowing of right tibia, cerebral hemorrhage (7) Malformed kidneysmarkedly reduced size and malpositioned (8) Data from one review indicated that 40% of the infants exposed to anticancer drugs were of low birth weight (4). Long-term studies of growth and mental development in offspring exposed to mechlorethamine during the 2nd trimester, the period of neuroblast multiplication, have not been conducted (9).

Ovarian function has been evaluated in 27 women previously treated with mechlorethamine and other antineoplastic drugs (10). Excluding three patients who received pelvic radiation, 13 (54%) maintained regular cyclic menses and, overall, 13 normal children were born after therapy. Other successful pregnancies have been reported following combination chemotherapy with mechlorethamine (11,12,13,14,15,16 and 17). Ovarian failure is apparently often gradual in onset and is age related (10). Mechlorethamine therapy in males has been observed to produce testicular germinal cell depletion and azoospermia (15,16,18,19).

Occupational exposure of the mother to antineoplastic agents during pregnancy may present a risk to the fetus. A position statement from the National Study Commission on Cytotoxic Exposure and a research article involving some antineoplastic agents are presented in the monograph for cyclophosphamide (see Cyclophosphamide).

Breast Feeding Summary

No reports describing the use of mechlorethamine during lactation have been located. The low molecular weight (about 193 for the hydrochloride salt) probably indicates that the drug passes into milk. Although it undergoes rapid chemical transformation in water and body fluids, it is not known if exposure to this biologic alkylating agent in breast milk poses a significant risk to a nursing infant. Because of the potential for serious adverse reactions, however, breast feeding should be discontinued while the mother is receiving therapy.

References

1. Product information. Mustargen. Merck, 2000.
2. Hennessy JP, Rottino A. Hodgkin's disease in pregnancy with a report of twelve cases. Am J Obstet Gynecol 1952;63:75664.
3. Riva HL, Andreson PS, O'Grady JW. Pregnancy and Hodgkin's disease: a report of eight cases. Am J Obstet Gynecol 1953;66:86670.
4. Nicholson HO. Cytotoxic drugs in pregnancy: review of reported cases. J Obstet Gynaecol Br Commonw 1968;75:30712.
5. Jones RT, Weinerman ER. MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) given during pregnancy. Obstet Gynecol 1979;54:4778.
6. Johnson IR, Filshie GM. Hodgkin's disease diagnosed in pregnancy: case report. Br J Obstet Gynaecol 1977;84:7912.
7. Garrett MJ. Teratogenic effects of combination chemotherapy. Ann Intern Med 1974;80:667.
8. Mennuti MT, Shepard TH, Mellman WJ. Fetal renal malformation following treatment of Hodgkin's disease during pregnancy. Obstet Gynecol 1975;46:1946.
9. Dobbing J. Pregnancy and leukaemia. Lancet 1977;1:1155.
10. Schilsky RL, Sherins RJ, Hubbard SM, Wesley MN, Young RC, DeVita VT Jr. Long-term follow-up of ovarian function in women treated with MOPP chemotherapy for Hodgkin's disease. Am J Med 1981;71:5526.
11. Ross GT. Congenital anomalies among children born of mothers receiving chemotherapy for gestational trophoblastic neoplasms. Cancer 1976;37:10437.
12. Johnson SA, Goldman JM, Hawkins DF. Pregnancy after chemotherapy for Hodgkin's disease. Lancet 1979;2:93.
13. Whitehead E, Shalet SM, Blackledge G, Todd I, Crowther D, Beardwell CG. The effect of combination chemotherapy on ovarian function in women treated for Hodgkin's disease. Cancer 1983;52:988993.
14. Andrieu JM, Ochoa-Molina ME. Menstrual cycle, pregnancies and offspring before and after MOPP therapy for Hodgkin's disease. Cancer 1983;52:4358.
15. Dein RA, Mennuti MT, Kovach P, Gabbe SG. The reproductive potential of young men and women with Hodgkin's disease. Obstet Gynecol Surv 1984;39:47482.
16. Schilsky RL, Lewis BJ, Sherins RJ, Young RC. Gonadal dysfunction in patients receiving chemotherapy for cancer. Ann Intern Med 1980;93:10914.
17. Shalet SM, Vaughan Williams CA, Whitehead E. Pregnancy after chemotherapy induced ovarian failure. Br Med J 1985;290:898.
18. Sherins RJ, Olweny CLM, Ziegler JL. Gynecomastia and gonadal dysfunction in adolescent boys treated with combination chemotherapy for Hodgkin's disease. N Engl J Med 1978;299:126.
19. Sherins RJ, DeVita VT Jr. Effect of drug treatment for lymphoma on male reproductive capacity: studies of men in remission after therapy. Ann Intern Med 1973;79:21620.
    
    

Questions and Answers

where can i buy mechlorethamine,a cancer medication. cost is over 1000.00 here?,

It's administered through a physician, just like most chemotherapy agents. It's not a bottle of pills you can buy over the internet and take them at home.