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CYC is a prodrug that undergoes hepatic conversion to its active metabolite, 4-hydroxycyclophosphamide (4-OH-CPA), primarily facilitated by cytochrome P450 (CYP) enzymes, including CYP2B6, CYP2C9, and CYP3A4, with additional contributions from CYP2A6, CYP2C8, and CYP2C19 ( GST (e.g., GSTM1 and GSTP1 ), CYPs , and aldehyde dehydrogenase ( ALDH ) genes have been associated with altered metabolism and increased risk of CYC-induced adverse effects in SLE patients (Illustrated in Figure 3) ( FIGURE 3 3.3.1 GST polymorphisms GST genes encode glutathione S-transferase (GST), an important enzyme involved in the detoxification of cyclophosphamide metabolites