Authors: Joshua Yehuda Kausman Lei Yin Colin Lindsay Jones Lillian Johnstone Harley Robert Powell
Publish Date: 2005/06/24
Volume: 20, Issue: 10, Pages: 1416-1419
Abstract
Treatment of children with steroiddependent nephrotic syndrome SDNS continues to be a challenge when relapses recur after treatment with cyclophosphamide and side effects or noncompliance make steroids and cyclosporin unsatisfactory We treated 12 patients with intravenous vincristine for SDNS in a regime of 1–15 mg/m2 weekly for 4 weeks then monthly for 4 months Four of the 5 patients in relapse when commencing vincristine remitted within 2 doses Comparing relapse frequency in the 12 months before and after vincristine there was a reduction from 4 to 15 p=0004 relapses per year Median sustained remission was 5 months but 1 frequently relapsing patient remains in remission 4 years after vincristine Vincristine was also successfully used in 1 or 2 doses at weekly intervals for subsequent relapses in 5 patients Side effects were minimal in most cases Abdominal pain occurred in 2 patients who commenced vincristine at 15 mg/m2 but resolved when continued at 1 mg/m2 We felt vincristine had a role in a subset of children with challenging SDNS administered as 1 mg/m2 weekly for 4 weeks then 15 mg/m2 monthly for 4 months Vincristine allowed steroid and cyclosporinsparing contributed to longterm remission in some patients and was especially valuable in children with poor compliance with oral medication Many patients expressed a preference for a few doses of vincristine rather than a standard course of oral prednisolone or cyclosporin
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