Safety of cyclophosphamide infusion time modification from 60 to 30 minutes in selected chemotherapy regimens for lymphoma and multiple myeloma

BackgroundShortening chemotherapy infusion times is associated with improvements in resource use and patient satisfaction, as well as reductions in nursing workload and clinic wait times. Cyclophosphamide package inserts mention that the drug should be injected or infused very slowly, but the exact duration of infusion is not specified. Per literature review, there is heterogeneity in infusion times among regimens for various conditions.MethodsThe aim was to analyze the incidence of documented adverse events (AEs) temporally related to cyclophosphamide when it was administered as either a 60- or 30-minute infusion. We performed a retrospective chart review of records between January 1, 2023, and January 31, 2024, including adult patients (age >= 18 years) who received at least one cyclophosphamide infusion over 60- or 30-minutes within selected chemotherapy regimens for lymphoma (CHOP +/- R; EPOCH +/- R; CHOEP +/- R) or multiple myeloma (MM) (CyBorD or VCD +/- Dara; KCyD +/- Dara) at any inpatient or outpatient site within Mount Sinai Health System (MSHS).ResultsAmong 200 consecutive doses evaluated per disease-based group (n = 400 total doses), there were more numerical occurrences of documented AEs in the 60-minute groups compared to 30-minutes groups (n = 4 vs. n = 2), but this finding was not statistically significant (2% vs. 1%; p > 0.05). There were no documented Grade 3 or higher AEs temporally related to cyclophosphamide infusion.ConclusionThe shortening of cyclophosphamide infusion times for selected chemotherapy regimens was determined to be a safe practice change.