Rekeland, Ingrid G, Fosså, Alexander, Lande, Asgeir et al. · Frontiers in medicine · 2020 · DOI
Researchers tested whether cyclophosphamide, a chemotherapy drug, could help people with ME/CFS based on observations that some patients improved after cancer treatment. Forty patients received six infusions of this drug over six months, with check-ins lasting up to four years. More than half the patients reported meaningful improvements in fatigue and physical activity, with many staying better even years later.
This study provides preliminary evidence that cyclophosphamide may induce sustained symptom remission in ME/CFS, addressing a disease with no established treatments. The identification of HLA alleles associated with treatment response offers potential biomarkers for patient stratification in future trials and suggests an immunological pathogenic mechanism.
Without a placebo control, this study cannot definitively separate drug effect from natural history, regression to the mean, or expectations associated with intensive medical intervention. The open-label design introduces bias, and the small sample size limits generalizability. Long-term spontaneous remission rates in untreated ME/CFS are unknown, making it difficult to attribute observed improvements solely to cyclophosphamide.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Rekeland, Ingrid G, Fosså, Alexander, Lande, Asgeir, Ktoridou-Valen, Irini, Sørland, Kari, Holsen, Mari, et al. (2020). Intravenous Cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An Open-Label Phase II Study.. Frontiers in medicine. https://doi.org/10.3389/fmed.2020.00162
BibTeX
@article{mecfsatlas-rekeland-2020-intravenous-cyclophosphamide,
author = {Rekeland, Ingrid G and Fosså, Alexander and Lande, Asgeir and Ktoridou-Valen, Irini and Sørland, Kari and Holsen, Mari and Tronstad, Karl J and Risa, Kristin and Alme, Kine and Viken, Marte K and Lie, Benedicte A and Dahl, Olav and Mella, Olav and Fluge, Øystein},
title = {Intravenous Cyclophosphamide in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An Open-Label Phase II Study.},
journal = {Frontiers in medicine},
year = {2020},
doi = {10.3389/fmed.2020.00162},
note = {PubMed: 32411717},
url = {https://www.mecfsatlas.com/evidence/rekeland-2020-intravenous-cyclophosphamide},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/rekeland-2020-intravenous-cyclophosphamide
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