Why is mesna given with ifosfamide therapy?

• A. Mesna binds acrolein, a urotoxic metabolite of ifosfamide, to prevent hemorrhagic cystitis; ensure adequate hydration.
• B. Mesna reduces nephrotoxicity of ifosfamide.
• C. Mesna prevents neuropathy associated with ifosfamide.
• D. Mesna accelerates clearance of ifosfamide from the bloodstream.

Answer: (A)

The main idea is protecting the bladder from a toxic byproduct of ifosfamide. When ifosfamide is broken down in the body, it forms acrolein in the urinary tract, which can irritate and damage the bladder lining and lead to hemorrhagic cystitis. Mesna provides sulfhydryl groups that bind to acrolein in the urine, forming a non-toxic complex that is excreted, thereby shielding the urothelium from injury. Adequate hydration supports flushing of the bladder and helps dilute and eliminate both acrolein and mesna, further reducing risk. Mesna specifically targets this urotoxic metabolite; it does not prevent nephrotoxicity, neuropathy, or alter the overall clearance of ifosfamide.