These compounds are toxic to rapidly producing cells eg bone marrow cells and germ cells. Myelosuppression is the dose-limiting side effect with the nadir of the full blood count ranging from 10 to 28 days after treatment.
Alkylating agents may cause reduced fertility in women, and permanent infertility in men.
Long-term treatment with alkylating drugs may cause irreversible bone marrow damage and leukaemogenesis.
Other toxic effects are specific to different alkylating agents such as bladder toxicity with ifosfamide due to excretion of active drug in the urine.
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