Which protective agent is given to prevent cyclophosphamide-induced urothelial toxicity?

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Cyclophosphamide’s toxic metabolite, acrolein, can irritate the bladder lining and cause hemorrhagic cystitis. A protective agent works by neutralizing acrolein in the urine, preventing urothelial injury. Mesna provides sulfhydryl groups that chemically bind acrolein to form non-toxic adducts that are excreted, thereby reducing urothelial toxicity. It’s used prophylactically with cyclophosphamide regimens to lower the risk of hemorrhagic cystitis. The other options have different roles: antiemetics relieve chemotherapy‑induced nausea, and filgrastim stimulates neutrophil recovery, neither of which protects the bladder from acrolein.