Several studies have revealed that chemotherapy medications used mostly in patients with haematological malignancy were alkylating agents
, anti-metabolites, vinca alkaloids, and the patients experienced more grade 2 mucositis.20 It was determined in the present study that most of the patients received alkylating agent
therapy had grade 0 and grade 1 mucositis.
According to previous researches, alkylating agents
, specifically busulfan and melphalan, are associated with the development of FNH when administered prior to bone marrow transplant due to SOS .
These three patients with multiple myeloma and ESRD were treated with alkylating agents
and autologous HSCT; each had prolonged infection and developed severe SOS in case 1, very severe SOS in case 2, and moderate SOS in case 3 based on proposed grading of SOS severity by EBMT criteria  (Table 1).
A large prospective study of 215 patients with malignancy who had 317 total neutropenic episodes showed that 72.7% of patients with NE were on antimetabolites, 72.7% were on anthracyclines, and 36.4% were on alkylating agents
The latency between previous cancer treatment and leukemia development is longer after alkylating agents
(3-8 years) and shorter after topoisomerase II inhibitors (2-3 years).[sup] The incidence of SPM after MM has been reported to be 3.30-10.40% in Western countries, in which a high incidence of t-MDS/AML and melanoma has been observed.
This would include patients diagnosed with cancers known to require exposure to known gonadotoxic agents (such as high doses of alkylating agents
, as seen in cases of rhabdomyosarcoma, Ewing's sarcoma, neuroblastoma, Hodgkin's lymphoma) or radiation to achieve cure (e.g., patients undergoing total-body irradiation prior to bone marrow transplantation), or else tumours directly affecting the gonads (testicular germ cell tumour or paratesticular rhabdomyosarcoma).
A study of the stability of three phase-transfer catalysts to afford five different nucleophiles suggests the feasibility of quaternary ammonium salts acting as alkylating agents
for certain carbon and sulfur nucleophiles  and demonstrates the reaction of thiolate nucleophiles with a catalyst in preference to the substrate.
However, suboptimal response may require further treatment with other therapeutic options such as chemotherapy with alkylating agents
or high-dose Melphalan with autologous stem cell transplant.
If the criteria for immunosuppressive therapy are met, KDIGO guidelines recommend to primarily use alkylating agents
(cyclophosphamide) in combination with corticosteroids for 6 months .
Immunosuppressant drugs include antimetabolites, alkylating agents
, some antibiotics and specific adjuvants.
, for example, are more likely to contribute to the development of leukemia than cisplatin or carboplatin.
Most of the treatment protocols used in Brazil for treating MM are composed of bortezomib and/or thalidomide, combined with other drugs such as alkylating agents
and corticosteroids (1).