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Metabolic pathway of cyclophosphamide. The hepatic cytochrome P-450 enzyme (CYP) system (CYP2B6, 2C9, 2C19, and 3A4) metabolises cyclophosphamide (CY) to 4-hydroxy-cyclophosphamide (4-HCY). Subsequently, 4-HCY is oxidised to its tautomer aldocyclophosphamide (AldoCY), absorbed by cells, and converted to phosphoramide mustard (PM) and acrolein via β-elimination. AldoCY can be oxidised to o-carboxyethylphosphoramide mustard (CEPM) by aldehyde dehydrogenase 1 (ALDH1).
