Occupational exposure to cyclophosphamide

Several lines of research have demonstrated the risk of occupational exposure of health-care personnel to anticancer drugs. Urine samples from two nurses working in a cancer clinic were analysed for cyclophosphamide (CP) by gas chromatography after they had prepared the drug for treatment. Since the drug might be absorbed through the skin, urine samples from five volunteers were also examined after a solution of CP had been applied topically to the cubital fossa area. Variable quantities of intact CP were identified in samples from the volunteers collected over 24 h, but in most cases the drug was evident only in urine samples given more than 6 h after application. CP was found in several urine samples from the nurses, but the quantities of CP in these samples were not related to the amounts of drug handled. The identity of CP was confirmed by gas-chromatography/mass-spectrometry. CP appeared sooner in the urine samples from the nurses than in those from the volunteers, suggesting a faster route of absorption, perhaps through inhalation of aerosols generated during dissolution of the drug. These findings suggest that the increased levels of mutagenicity observed in urine samples of nurses who worked on oncology wards might have arisen, in part, from metabolites of CP.