(FDA approved in bold)

• Treatment of malignancies, including lymphomas (lymphocytic, mixed-cell type, histiocytic, Burkitt’s, and Hodgkin’s disease), disseminated neuroblastoma, ovarian adenocarcinoma and breast
  
• Other malignancies: bronchogenic, small-cell lung, endometrial, prostate, testicular, and sarcomas
  
• Mycosis fungoides
  
• “Minimal change” nephrotic syndrome in children
  
• Myasthenia gravis (MG)
  
• Multiple sclerosis (MS) (relapsing remitting)
  
• Polymyositis and dermatomyositis
  
• Multifocal motor neuropathy
  
• Vasculitis including Wegener’s granulomatosis, polyarteritis nodosa
  
• Rheumatoid arthritis
  
• Systemic lupus erythematosus
  
• Bone marrow transplantation

• An alkylating agent and non-specific cell-cycle inhibitor with metabolites that interfere with the growth of rapidly proliferating normal and malignant cells, most likely by cross-linking of tumor cell DNA

• Within a week, but effect on neurological diseases may take months

• MG: May allow improvement in symptoms or reduction in dose or discontinuation of corticosteroids or other agents
  
• MS: May reduce relapses and new lesions on MRI
  
• Other disorders: Improves symptoms (weakness, sensory changes) and clinical markers of the disease

• Usually used as a disease-modifying agent in refractory cases when first-line agents have failed

• Often used in combination with other agents depending on the disease in question, such as corticosteroids for vasculitis or MG and plasma exchange for multifocal motor neuropathy

• Obtain complete blood counts regularly during treatment to determine WBC and platelet counts. Examine urine for red cells (hemorrhagic cystitis)