Cyclophosphamide treatment with a comparison in both pediatric rheumatology and pediatric nephrology practices

被引：0

作者：

Gezgin Yildirim, Deniz ^{[1
]}

Orulluoglu, Emine Yilmaz ^{[2
]}

Yildiz, Cisem ^{[1
]}

Acari, Ceyhun ^{[3
]}

Dundar, Hatice Adiguzel ^{[4
]}

Akaci, Okan ^{[5
]}

Akinci, Nurver ^{[6
]}

Aliyev, Emil ^{[7
]}

Alpman, Bedriye Nuray ^{[8
]}

Altug Gucenmez, Ozge ^{[9
]}

Arslanoglu Aydin, Elif ^{[10
]}

Atmis, Bahriye ^{[11
]}

Avar Aydin, Pinar Ozge ^{[12
]}

Aydin, Fatma ^{[13
]}

Baba, Ozge ^{[14
]}

Baglan, Esra ^{[10
]}

Bagrul, Ilknur ^{[10
]}

Barut, Kenan ^{[15
]}

Basaran, Ozge ^{[7
]}

Bayrakci, Umut Selda ^{[16
]}

Belder, Nuran ^{[1
]}

Yucel, Burcu Bozkaya ^{[17
]}

Buyukkaragoz, Bahar ^{[18
]}

Caglayan, Sengul ^{[19
]}

Cakan, Mustafa ^{[20
]}

Celikel, Elif ^{[21
]}

Demir, Ferhat ^{[22
]}

Demir, Selcan ^{[23
]}

Demir Yigit, Yasemin ^{[24
]}

Demirkan, Fatma Gul ^{[25
]}

Dincel, Nida ^{[26
]}

Dogantan, Seyda ^{[27
]}

Ekici Tekin, Zahide ^{[21
]}

Genc, Esra ^{[28
]}

Haslak, Fatih ^{[15
]}

Isguder, Rana ^{[4
]}

Kara, Aslihan ^{[28
]}

Kasap Cuceoglu, Muserref ^{[7
]}

Kaya Akca, Ummusen ^{[29
]}

Kisaoglu, Hakan ^{[30
]}

Kisla Ekinci, Rabia Miray ^{[31
]}

Kizildag, Zehra ^{[4
]}

Kurt, Tuba ^{[32
]}

Kucukali, Batuhan ^{[1
]}

Leventoglu, Emre ^{[33
]}

Nalcacioglu, Hulya ^{[34
]}

Yener, Gulcin Otar ^{[35
]}

Ozdel, Semanur ^{[10
]}

Ozdemir Atikel, Yesim ^{[36
]}

Ozdemir Cicek, Sumeyra ^{[37
]}

机构：

[1] Gazi Univ, Fac Med, Dept Pediat Rheumatol, Ankara, Turkiye

[2] Gazi Univ, Fac Med, Dept Pediat, Ankara, Turkiye

[3] Inonu Univ, Fac Med, Dept Pediat Rheumatol, Malatya, Turkiye

[4] Dokuz Eylul Univ, Fac Med, Dept Pediat Rheumatol, Izmir, Turkiye

[5] Bursa City Hosp, Dept Pediat, Bursa, Turkiye

[6] Bezmialem Vakif Univ, Fac Med, Dept Pediat Nephrol, Istanbul, Turkiye

[7] Hacettepe Univ, Fac Med, Dept Pediat Rheumatol, Ankara, Turkiye

[8] Baskent Univ, Sch Med, TR-06490 Ankara, Turkiye

[9] Dr Behcet Uz Pediat Dis & Surg Training & Res Hosp, Dept Ophthalmol, Izmir, Turkiye

[10] Ankara Etlik City Hosp, Dept Pediat Rheumatol, Ankara, Turkiye

[11] Cukurova Univ, Fac Med, Dept Pediat Nephrol, Adana, Turkiye

[12] Tekirdag City Hosp, Dept Ophthalmol, Tekirdag, Turkiye

[13] Ankara Univ, Fac Med, Dept Pediat Rheumatol, Ankara, Turkiye

[14] Ipekyolu City Hosp, Dept Anaesthesiol & Reanimat, Van, Turkiye

[15] Istanbul Univ, Cerrahpasa Fac Med, Dept Pediat Rheumatol, Istanbul, Turkiye

[16] Ankara Bilkent City Hosp, Dept Pediat Nephrol, Ankara, Turkiye

[17] Samsun Training & Res Hosp, Dept Pediat Rheumatol, Samsun, Turkiye

[18] Gazi Univ, Fac Med, Dept Pediat Nephrol, Ankara, Turkiye

[19] Antalya City Hosp, Dept Pediat Rheumatol, Antalya, Turkiye

[20] Zeynep Kamil Training & Res Hosp, Dept Perinatol, Istanbul, Turkiye

[21] Ankara Bilkent City Hosp, Dept Pediat Rheumatol, Ankara, Turkiye

[22] Acibadem Healthcare Grp, Dept Pediat Rheumatol, Istanbul, Turkiye

[23] Eskisehir Osmangazi Univ, Fac Med, Dept Pediat, Eskisehir, Turkiye

[24] Firat Univ, Fac Med, Dept Pediat Rheumatol, Elazig, Turkiye

[25] Kanuni Sultan Suleyman Training & Res Hosp, Dept Pediat Rheumatol, Istanbul, Turkiye

[26] Dr Behcet Uz Pediat Dis & Surg Training & Res Hosp, Dept Ophthalmol, Izmir, Turkiye

[27] Basaksehir Cam & Sakura City Hosp, Dept Pathol, Istanbul, Turkiye

[28] Firat Univ, Fac Med, Dept Pediat Nephrol, Elazig, Turkiye

[29] Akdeniz Univ, Fac Med, Dept Nephrol, Antalya, Turkiye

[30] Kayseri City Hosp, Dept Pediat Rheumatol, Kayseri, Turkiye

[31] Cukurova Univ, Fac Med, Dept Pediat Rheumatol, Adana, Turkiye

[32] Bursa City Hosp, Dept Pediat Rheumatol, Bursa, Turkiye

[33] Dept Pediat Nephrol, Bursa, Turkiye

[34] Ondokuz Mayis Univ, Fac Med, Dept Pediat Nephrol, Samsun, Turkiye

[35] Eskisehir City Hosp, Dept Hematol, Eskisehir, Turkiye

[36] Eskisehir City Hosp, Dept Pediat Nephrol, Eskisehir, Turkiye

[37] Erciyes Univ, Fac Med, Dept Pediat Rheumatol, Kayseri, Turkiye

[38] Eskisehir Osmangazi Univ, Fac Med, Dept Pediat Nephrol, Eskisehir, Turkiye

[39] Kocaeli Univ, Fac Med, Dept Pediat Rheumatol, Kocaeli, Turkiye

[40] Mersin Univ, Fac Med, Dept Pediat Nephrol, Mersin, Turkiye

[41] Marmara Univ, Fac Med, Dept Rheumatol, Istanbul, Turkiye

[42] Gaziantep Univ, Fac Med, Dept Pediat Nephrol, Gaziantep, Turkiye

[43] Pamukkale Univ, Fac Med, Dept Pediat Rheumatol, Denizli, Turkiye

[44] Ankara Etlik City Hosp, Dept Pediat Nephrol, Ankara, Turkiye

[45] Marmara Univ, Fac Med, Dept Pediat Nephrol, Istanbul, Turkiye

[46] Sanliurfa Training Hosp, Dept Pediat Nephrol, Sanliurfa, Turkiye

[47] Inonu Univ, Fac Med, Dept Pediat Nephrol, Malatya, Turkiye

[48] Erciyes Univ, Fac Med, Dept Pediat Nephrol, Kayseri, Turkiye

[49] Istanbul Univ, Dept Pediat Nephrol, Cerrahpasa Med Fac, TR-34303 Istanbul, Turkiye

[50] Ege Univ, Fac Med, Dept Pediat Nephrol, Izmir, Turkiye

来源：

PEDIATRIC RHEUMATOLOGY | 2025年 / 23卷 / 01期

关键词：

Cyclophosphamide; Pediatric nephrology; Pediatric rheumatology; Rituximab; Side effects; Vaccination; SYSTEMIC-LUPUS-ERYTHEMATOSUS; THERAPY; NEPHRITIS; RISK;

D O I：

10.1186/s12969-025-01080-9

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

BackgroundCyclophosphamide (CYC) is an inactive alkylating agent that transforms the alkyl radicals into other molecules and is used in combination with systemic corticosteroids in the treatment of many childhood rheumatic diseases, such as systemic lupus erythematosus (SLE), and ANCA-associated vasculitis (AAV). In recent years, rituximab (RTX), a B-cell-targeting anti-CD20 monoclonal antibody, has emerged as a new alternative treatment modality over CYC for induction therapy of childhood-onset rheumatic diseases. Clinicians adopt different practices for using CYC particularly in relation to indications, posology, pre-treatment laboratory work-up, post-treatment follow-up, and screening pre- and post-treatment vaccination status. This study aimed to evaluate the principles and approaches of administering CYC therapy in pediatric rheumatology and pediatric nephrology practices and to compare the clinician preferences for CYC and RTX in induction therapy of childhood-onset rheumatic diseases.MethodsThis study includes a web-based questionnaire executed on 87 participants (56 pediatric rheumatologists (PRs) and 31 pediatric nephrologists (PNs)). Both pediatric subspecialties evaluated and compared the most common indications for CYC treatment, pre-treatment consent protocols, pre-and post-treatment laboratory tests, dosing strategies, and side effects.ResultsChildhood-onset SLE (95%) and AAV (69%) were the most common diseases for which CYC treatment is used. All clinicians, except 2 PNs prescribed CYC via intravenous route. 61% of the PRs and 71% of PNs reported using a monthly dose of 500 mg/m(2) CYC for 6 months in accordance with the National Institutes of Health (NIH) protocol. All clinicians conducted pre-CYC treatment assessments of complete blood count and kidney function tests. Hepatitis B (82%), chickenpox (76%), and mumps-measles-rubella (72%) were the most frequently assessed vaccines. Adverse effects associated with CYC include cytopenia (86%), nausea (52%), liver toxicity (20%), hair loss (31%), hemorrhagic cystitis (37%), allergic reactions (16%), dyspnea (5%), and infertility (2%). 9 clinicians stated that they performed gonad-sparing interventions before CYC, which clarifies why CYC was more commonly preferred in the induction therapy of SLE and AAV over RTX by both PRs and PNs.ConclusionsClinicians still tend to choose CYC over RTX in induction therapy of SLE and AAV and mostly prefer the high-dose CYC treatment regimen suggested by the NIH.

引用

页数：12

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