title: Cyclophosphamide and rituximab in frequently relapsing/steroid-dependent nephrotic syndrome.
abstract: BACKGROUND
  Steroid-sensitive nephrotic syndrome is the most common form of nephrotic syndrome in childhood, defined by the response to treatment with glucocorticoids with consequent remission. While most children eventually experience spontaneous resolution of the disease, some have a difficult course with frequent relapses or steroid dependence nephrotic syndrome (FRSDNS). The consequent steroid toxicity often prompts administration of other immunosuppressive drugs, traditionally cyclophosphamide. Recently, rituximab has been reported as effective in this disorder, but long-term experience is lacking.
  
  
  METHODS
  Retrospective note review of all children with FRSDNS treated with a first course of cyclophosphamide and/or rituximab in our center between December 2006 and April 2015. We reviewed time to first relapse after treatment, co-medications, and side effects.
  
  
  RESULTS
  A total of 102 children were treated with cyclophosphamide (79) and/or rituximab (42). Of these, 34 received cyclophosphamide prior to rituximab. Median time to first relapse was 7 months after cyclophosphamide and 14 months after rituximab. Documented side effects of cyclophosphamide included neutropenia, hair loss, and hemorrhagic cystitis (1). Rituximab was associated with an allergic reaction at infusion in two patients.
  
  
  CONCLUSIONS
  Rituximab was used in children with the most difficult to treat FRSDNS, yet was associated with longer remission time and less side effects than cyclophosphamide. A randomized controlled trial is needed to directly compare these drugs.
authors.affiliation: Department of Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust London UK and UCL Institute of Child Health, London, WC1N 3JH, UK.
authors.forename: Hazel
authors.initials: H
authors.lastname: Webb
authors.affiliation: Department of Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust London UK and UCL Institute of Child Health, London, WC1N 3JH, UK.
authors.forename: Graciana
authors.initials: G
authors.lastname: Jaureguiberry
authors.affiliation: Department of Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust London UK and UCL Institute of Child Health, London, WC1N 3JH, UK.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dufek
authors.affiliation: Department of Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust London UK and UCL Institute of Child Health, London, WC1N 3JH, UK. kjell.tullus@gosh.nhs.uk.
authors.forename: Kjell
authors.initials: K
authors.lastname: Tullus
authors.affiliation: Department of Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust London UK and UCL Institute of Child Health, London, WC1N 3JH, UK.
authors.forename: Detlef
authors.initials: D
authors.lastname: Bockenhauer
mesh_terms: D002648:Child; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008131:London; D008297:Male; D009404:Nephrotic Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D000069283:Rituximab / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide
keywords: Cyclophosphamide; Frequently relapsing nephrotic syndrome; Outcome; Rituximab; Steroid dependent nephrotic syndrome