Cyclophosphamide treatment with a comparison in both pediatric rheumatology and pediatric nephrology practices.
| Title: | Cyclophosphamide treatment with a comparison in both pediatric rheumatology and pediatric nephrology practices. |
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| Authors: | Gezgin Yildirim D; Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, 21000, Turkey. denizgezgin@gazi.edu.tr.; Orulluoglu EY; Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey.; Yildiz C; Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, 21000, Turkey.; Acari C; Department of Pediatric Rheumatology, Faculty of Medicine, Inonu University, Malatya, Turkey.; Dundar HA; Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.; Akaci O; Department of Pediatric Nephrology, Bursa City Hospital, Bursa, Turkey.; Akinci N; Department of Pediatric Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.; Aliyev E; Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.; Alpman BN; Department of Pediatric Nephrology, Gülhane School of Medicine, Ankara, Turkey.; Altug Gucenmez O; Department of Pediatric Rheumatology, Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkey.; Arslanoglu Aydin E; Department of Pediatric Rheumatology, Ankara Etlik City Hospital, Ankara, Turkey.; Atmis B; Department of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey.; Avar Aydin PO; Department of Pediatric Rheumatology, Tekirdag City Hospital, Tekirdag, Turkey.; Aydin F; Department of Pediatric Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey.; Baba O; Department of Pediatric Rheumatology, Van City Hospital, Van, Turkey.; Baglan E; Department of Pediatric Rheumatology, Ankara Etlik City Hospital, Ankara, Turkey.; Bagrul I; Department of Pediatric Rheumatology, Ankara Etlik City Hospital, Ankara, Turkey.; Barut K; Department of Pediatric Rheumatology, Cerrahpaşa Faculty of Medicine, İstanbul University, Istanbul, Turkey.; Basaran O; Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.; Bayrakci US; Department of Pediatric Nephrology, Ankara Bilkent City Hospital, Ankara, Turkey.; Belder N; Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, 21000, Turkey.; Yucel BB; Department of Pediatric Rheumatology, Samsun Training and Research Hospital, Samsun, Turkey.; Buyukkaragoz B; Department of Pediatric Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey.; Caglayan S; Department of Pediatric Rheumatology, Antalya City Hospital, Antalya, Turkey.; Cakan M; Department of Pediatric Rheumatology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey.; Celikel E; Department of Pediatric Rheumatology, Ankara Bilkent City Hospital, Ankara, Turkey.; Demir F; Department of Pediatric Rheumatology, Acıbadem Healthcare Group, Istanbul, Turkey.; Demir S; Department of Pediatric Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey.; Demir Yigit Y; Department of Pediatric Rheumatology, Fırat University Faculty of Medicine, Elazig, Turkey.; Demirkan FG; Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey.; Dincel N; Department of Pediatric Nephrology, Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkey.; Dogantan S; Department of Pediatric Rheumatology, Basaksehir Cam ve Sakura City Hospital, İstanbul, Turkey.; Ekici Tekin Z; Department of Pediatric Rheumatology, Ankara Bilkent City Hospital, Ankara, Turkey.; Genc E; Department of Pediatric Nephrology, Faculty of Medicine, Fırat University, Elazig, Turkey.; Haslak F; Department of Pediatric Rheumatology, Cerrahpaşa Faculty of Medicine, İstanbul University, Istanbul, Turkey.; Isguder R; Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.; Kara A; Department of Pediatric Nephrology, Faculty of Medicine, Fırat University, Elazig, Turkey.; Kasap Cuceoglu M; Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.; Kaya Akca U; Department of Pediatric Rheumatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.; Kisaoglu H; Department of Pediatric Rheumatology, Kayseri City Hospital, Kayseri, Turkey.; Kisla Ekinci RM; Department of Pediatric Rheumatology, Faculty of Medicine, Cukurova University, Adana, Turkey.; Kızıldag Z; Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.; Kurt T; Department of Pediatric Rheumatology, Bursa City Hospital, Bursa, Turkey.; Kucukali B; Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, 21000, Turkey.; Leventoglu E; Department of Pediatric Nephrology, Konya City Hospital, Bursa, Turkey.; Nalcacioglu H; Department of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.; Yener GO; Department of Pediatric Rheumatology, Eskisehir City Hospital, Eskisehir, Turkey.; Ozdel S; Department of Pediatric Rheumatology, Ankara Etlik City Hospital, Ankara, Turkey.; Ozdemir Atikel Y; Department of Pediatric Nephrology, Eskisehir City Hospital, Eskisehir, Turkey.; Ozdemir Cicek S; Department of Pediatric Rheumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.; Pektas Leblebiciler S; Department of Pediatric Nephrology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey.; Serdaroglu E; Department of Pediatric Nephrology, Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkey.; Sonmez HE; Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.; Sunar Yayla EN; Department of Pediatric Rheumatology, Ankara Etlik City Hospital, Ankara, Turkey.; Surmeli Doven S; Department of Pediatric Nephrology, Faculty of Medicine, Mersin University, Mersin, Türkiye, Turkey.; Sahin S; Department of Pediatric Rheumatology, Cerrahpaşa Faculty of Medicine, İstanbul University, Istanbul, Turkey.; Sener S; Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.; Tanatar A; Department of Pediatric Rheumatology, Faculty of Medicine, Marmara University, Istanbul, Turkey.; Tanidir M; Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, 21000, Turkey.; Taskin SN; Department of Pediatric Rheumatology, Eskisehir City Hospital, Eskisehir, Turkey.; Tiryaki B; Department of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.; Tuncez S; Department of Pediatric Rheumatology, Ankara Etlik City Hospital, Ankara, Turkey.; Turkucar S; Department of Pediatric Rheumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey.; Uzun Kenan B; Department of Pediatric Nephrology, Ankara Etlik City Hospital, Ankara, Turkey.; Yildiz N; Department of Pediatric Nephrology, Faculty of Medicine, Marmara University, Istanbul, Turkey.; Yilmaz K; Department of Pediatric Nephrology, Sanlıurfa Training Hospital, Sanlıurfa, Turkey.; Tabel Y; Department of Pediatric Nephrology, Faculty of Medicine, Inonu University, Malatya, Turkey.; Dursun I; Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.; Canpolat N; Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, İstanbul, Turkey.; Mir S; Department of Pediatric Nephrology, Faculty of Medicine, Ege University, Izmir, Turkey.; Peru H; Department of Pediatric Nephrology, Faculty of Medicine, Selcuk University, Konya, Turkey.; Topaloglu R; Department of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.; Kaya Gurgoze M; Department of Pediatric Nephrology, Faculty of Medicine, Fırat University, Elazig, Turkey.; Balat A; Department of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.; Bilginer Y; Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.; Celikel Acar B; Department of Pediatric Rheumatology, Ankara Bilkent City Hospital, Ankara, Turkey.; Sozeri B; Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, Istanbul, Turkey.; Unsal E; Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.; Kasapcopur O; Department of Pediatric Rheumatology, Cerrahpaşa Faculty of Medicine, İstanbul University, Istanbul, Turkey.; Bakkaloglu SA; Department of Pediatric Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey. |
| Source: | Pediatric rheumatology online journal [Pediatr Rheumatol Online J] 2025 Mar 11; Vol. 23 (1), pp. 24. Date of Electronic Publication: 2025 Mar 11. |
| Publication Type: | Journal Article; Comparative Study |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Country of Publication: England NLM ID: 101248897 Publication Model: Electronic Cited Medium: Internet ISSN: 1546-0096 (Electronic) Linking ISSN: 15460096 NLM ISO Abbreviation: Pediatr Rheumatol Online J Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2007- : [London] : BioMed Central; Original Publication: [Chicago, Ill. : University of Chicago, 2003]- |
| MeSH Terms: | Cyclophosphamide*/therapeutic use ; Cyclophosphamide*/administration & dosage ; Cyclophosphamide*/adverse effects ; Lupus Erythematosus, Systemic*/drug therapy ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis*/drug therapy ; Practice Patterns, Physicians'*/statistics & numerical data ; Immunosuppressive Agents*/therapeutic use ; Immunosuppressive Agents*/administration & dosage ; Rheumatic Diseases*/drug therapy; Rituximab/therapeutic use ; Rheumatology/methods ; Humans ; Child ; Female ; Nephrology ; Male ; Pediatrics ; Surveys and Questionnaires |
| Abstract: | Background: Cyclophosphamide (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.; Methods: This 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.; Results: Childhood-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/m² 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.; Conclusions: Clinicians 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.; (© 2025. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. The present study was approved by the Ethics Committee of the Gazi University (2024, approval number: 1362). Consent for publication: Not applicable. Consent to participate: All participants consented to participate in the survey study. Competing interests: The authors declare no competing interests. |
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| Contributed Indexing: | Keywords: Cyclophosphamide; Pediatric nephrology; Pediatric rheumatology; Rituximab; Side effects; Vaccination |
| Substance Nomenclature: | 8N3DW7272P (Cyclophosphamide); 4F4X42SYQ6 (Rituximab); 0 (Immunosuppressive Agents) |
| Entry Date(s): | Date Created: 20250312 Date Completed: 20250312 Latest Revision: 20250512 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC11895381 |
| DOI: | 10.1186/s12969-025-01080-9 |
| PMID: | 40069880 |
| Database: | MEDLINE |
Journal Article; Comparative Study